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Rugg CM, Ginder JH, Bharadwaj A, Vomer R, Dale GA, Ketterly J, Zarzour H, Amendola A, Lau BC. Perioperative Management in the Collegiate Athlete: An Integrated Approach. Sports Med Int Open 2023; 7:E1-E8. [PMID: 37101550 PMCID: PMC10125641 DOI: 10.1055/a-2051-7756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/26/2023] [Indexed: 04/28/2023] Open
Abstract
Collegiate athletes face rigorous physical, academic, and emotional demands. While significant attention has been paid to injury prevention among young athletes in the past two decades, orthopedic injury rates remain high among collegiate athletes, and a significant number will undergo surgical management for injuries each year. In this narrative review, we describe techniques for perioperative management of pain and stress after surgery in collegiate athletes. In particular, we outline pharmacologic and non-pharmacologic management of surgical pain, with a goal of minimizing opiate consumption. We emphasize a multi-disciplinary approach to optimizing post-operative recovery in collegiate athletes help minimize reliance on opiate pain medication. Additionally, we recommend that institutional resources should be harnessed to support athletes in their well-being, from a nutritional, psychological and sleep standpoint. Critical to success in perioperative pain management is the communication among the athletic medicine team members and with the athlete and family to address pain and stress management and encourage timely, safe return to play.
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Affiliation(s)
| | | | | | - Rock Vomer
- Orthopedics, Division of Sports Medicine, Duke University, Durham,
United States
| | | | | | - Hap Zarzour
- Athletics, Duke University, Durham, United States
| | | | - Brian C. Lau
- Orthopedics, Duke University, Durham, United States
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Tourillon R, Bothorel H, McKeon PO, Gojanovic B, Fourchet F. Effects of a Single Electrical Stimulation Session on Foot Force Production, Foot Dome Stability, and Dynamic Postural Control. J Athl Train 2023; 58:51-59. [PMID: 35142810 PMCID: PMC9913059 DOI: 10.4085/1062-6050-0561.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Mounting evidence suggests neuromuscular electrical stimulation (NMES) as a promising modality for enhancing lower limb muscle strength, yet the functional effects of a single electrical stimulation session for improving the function of the intrinsic foot muscles (IFM) has not been evaluated. OBJECTIVE To investigate the immediate effects of an NMES session compared with a sham stimulation session on foot force production, foot dome stability, and dynamic postural control in participants with static foot pronation. DESIGN Randomized controlled clinical trial. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 46 participants (23 males, 23 females) with static foot pronation according to their Foot Posture Index (score ≥ 6) were randomly assigned to an NMES (n = 23) or control (n = 23) group. INTERVENTION(S) The NMES group received a single 15-minute NMES session on the dominant foot across the IFM. The control group received a 15-minute sham electrical stimulation session. MAIN OUTCOME MEASURE(S) All outcome measurements were assessed before and after the intervention and consisted of foot force production on a pressure platform, foot dome stability, and dynamic postural control. Statistical analysis was based on the responsiveness of the outcome measures and responder analysis using the minimum detectable change scores for each outcome measure. RESULTS In the NMES group, 78% of participants were classified as responders for at least 2 of the 3 outcomes, compared with only 22% in the control group. The relative risk of being a responder in the NMES group compared with the control group was 3.6 (95% CI = 1.6, 8.1]. Interestingly, we found that all participants who concomitantly responded to foot strength and navicular drop (n = 8) were also responders in dynamic postural control. CONCLUSIONS Compared with a sham stimulation session, a single NMES session was effective in immediately improving foot function and dynamic postural control in participants with static foot pronation. These findings support the role of NMES for improving IFM function in this population.
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Affiliation(s)
- Romain Tourillon
- UJM-Saint-Etienne Interuniversity Laboratory of Human Movement Biology, EA 7424, University of Lyon, France
- Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - Hugo Bothorel
- Research Department, La Tour Hospital, Meyrin, Switzerland
| | - Patrick O. McKeon
- Department of Exercise Science and Athletic Training, Ithaca College, NY
| | - Boris Gojanovic
- Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
| | - François Fourchet
- UJM-Saint-Etienne Interuniversity Laboratory of Human Movement Biology, EA 7424, University of Lyon, France
- Motion Analysis Lab, Physiotherapy and Sports Medicine Department, Swiss Olympic Medical Center, La Tour Hospital, Meyrin, Switzerland
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The Identification of Human Translational Biomarkers of Neuropathic Pain and Cross-Species Validation Using an Animal Model. Mol Neurobiol 2023; 60:1179-1194. [PMID: 36422814 PMCID: PMC9899164 DOI: 10.1007/s12035-022-03124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022]
Abstract
Neuropathic pain is a common chronic condition, which remains poorly understood. Many patients receiving treatment continue to experience severe pain, due to limited diagnostic/treatment management programmes. The development of objective clinical diagnostic/treatment strategies requires identification of robust biomarkers of neuropathic pain. To this end, we looked to identify biomarkers of chronic neuropathic pain by assessing gene expression profiles in an animal model of neuropathic pain, and differential gene expression in patients to determine the potential translatability. We demonstrated cross-species validation of several genes including those identified through bioinformatic analysis by assessing their expression in blood samples from neuropathic pain patients, according to conservative assessments of significance measured using Bonferroni-corrected p-values. These include CASP5 (p = 0.00226), CASP8 (p = 0.00587), CASP9 (p = 2.09 × 10-9), FPR2 (p = 0.00278), SH3BGRL3 (p = 0.00633), and TMEM88 (p = 0.00038). A ROC analysis revealed several combinations of genes to show high levels of discriminatory power in the comparison of neuropathic pain patients and control participants, of which the combination SH3BGRL3, TMEM88, and CASP9 achieved the highest level (AUROC = 0.923). The CASP9 gene was found to be common in five combinations of three genes revealing the highest levels of discriminatory power. In contrast, the gene combination PLAC8, ROMO1, and A3GALT2 showed the highest levels of discriminatory power in the comparison of neuropathic pain and nociceptive pain (AUROC = 0.919), when patients were grouped by S-LANSS scores. Molecules that demonstrate an active role in neuropathic pain have the potential to be developed into a biological measure for objective diagnostic tests, or as novel drug targets for improved pain management.
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Ying J, Xiao R, Xu L, Yan M. Transcutaneous Electrical Nerve Stimulation (TENS) for Opioid-Induced Constipation in Palliative Care: A Systematic Review and Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:5383821. [PMID: 37123082 PMCID: PMC10132909 DOI: 10.1155/2023/5383821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 05/02/2023]
Abstract
Background Opioid-induced constipation (OIC) has become increasingly prevalent with the rise of prescription opioid use, particularly in patients with advanced illnesses. Existing literature suggests that transcutaneous electrical nerve stimulation (TENS) could be applied to treat cancer pain and reduce OIC incidence. However, there need to be more systematic review studies on the effectiveness of TENS in treating OIC. Objective In order to fill the gap of TENS in treating OIC in current knowledge, we have conducted a systematic review and network meta-analysis. Methods The comprehensive computer retrieval PubMed, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), Chinese Biomedical (CBM), and Wanfang Database were used to collect literature for relevant studies of TENS treatment of OIC, in accordance with the standard of literature filtering, data extraction, and quality evaluation. The data were meta-analysed using ReviewManager 5.3 software recommended by Cochrane. Results A total of 180 pieces of literature were yielded through original search. Based on the inclusion and exclusion criteria, a total of 9 articles were included in this study. Our analysis of seven studies has revealed that TENS (28.18%) significantly reduces the incidence rate of OIC compared to control (52.45%) (I 2 = 57%, P=0.03; OR = 0.66 (95% CI, 0.53 to 0.82), Z = 3.70, P < 0.01). The results of two studies indicated that TENS significantly improved the quality of life compared to the control group (i.e., treatment-as-usual only) (I 2 = 80%, P=0.03; OR = -1.91; 95% CI, -2.54 to -1.29, Z = 6.00, P < 0.01). Conclusion The administration of TENS therapy holds the potential to mitigate the occurrence of OIC and augment the quality of life for individuals suffering from cancer. Particularly, TENS therapy proves to be appropriate for propagation within community and domestic environments. Nevertheless, advanced clinical randomized controlled trials of superior quality are necessary to authenticate the comprehensive clinical efficiency and safety of this therapy. Further investigation is indispensable to comprehend its mechanism in greater detail and establish the optimum therapeutic strategy.
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Affiliation(s)
- Jianyue Ying
- Campus Hospital of Zhejiang University, Zhejiang University, Hangzhou, Zhejiang, China
| | - Renzhong Xiao
- Hunan Royal Pharmaceutical Technology Co. Ltd., Changsha, Hunan, China
| | - Lili Xu
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Mei Yan
- Jinhua Municipal Central Hospital, Jinhua, Zhejiang, China
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Burris BJ, Bavarian R, Shaefer JR. Nonsurgical Management of Temporomandibular Joint Arthropathy. Dent Clin North Am 2023; 67:27-47. [PMID: 36404079 DOI: 10.1016/j.cden.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Arthropathy is a broad diagnostic term for any pathologic condition afflicting one or more joints of the body. Temporomandibular joint (TMJ) arthropathy is an umbrella term that may be applied to mechanical dysfunction or disease of one or both TMJs. This article provides evidence-based recommendations for conducting a patient evaluation, initiating a diagnostic workup, formulating an assessment, and instituting various nonsurgical modalities for the treatment of TMJ arthropathies.
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Affiliation(s)
- Briana J Burris
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA; Department of Oral and Maxillofacial Surgery, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Roxanne Bavarian
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA.
| | - Jeffry R Shaefer
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA; Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA
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Saedi N, Shokouhi N, Feizabad E, Moghimi Z, Mohseni M. Transcutaneous electrical nerve stimulation with the injection of pethidine and promethazine in the labor pain reduction: A randomized controlled trial. CASPIAN JOURNAL OF INTERNAL MEDICINE 2023; 14:628-632. [PMID: 38024177 PMCID: PMC10646370 DOI: 10.22088/cjim.14.4.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/20/2022] [Accepted: 07/31/2022] [Indexed: 09/26/2024]
Abstract
Background The use of transcutaneous electrical nerve stimulation (TENS) to relieve labor pain remains controversial and existing evidence is neither strong nor consistent. This research was designed to compare TENS' effect with the injection of pethidine and promethazine in labor pain reduction. Methods In this trial, for 45 pregnant women in the active phase of labor, TENS electrodes were placed (two on both arms, and two over the participants' low back) continuously for 120 minutes; and for another group 45 pregnant women, 100 milligrams of pethidine and 250 micrograms of promethazine were injected intramuscularly which could be repeated once at least one hour later. Labor pain and duration, need for labor induction/augmentation/other pain control methods/ instrumental delivery, delivery type, and maternal and newborn complications were measured in both groups. Results The baseline mean visual analog scale (VAS) score, in the TENS group was 8.51±0.62 and in the pethidine and promethazine groups was 8.37±0.61 (P=0.31). While in a 120min post-intervention, it was 6.29±1.50 and 5.73±1.46 in the TENS group and the pethidine and promethazine group, respectively with no statistically significant difference (P=0.07). The labor duration in the TENS group was 6.61±1.71 hours and in the pethidine and promethazine group was 6.17±2.07 hours, with no statistically significant difference (P=0.33). In addition, no complication was recorded neither in the mothers nor newborns. Conclusion This study showed that applying TENS in the active labor phase can reduce at least two scores in patient labor pain with no significant complications.
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Affiliation(s)
- Nafiseh Saedi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Shokouhi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Feizabad
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Moghimi
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Mohseni
- Department of Obstetrics and Gynecology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Efficacy of Fu's Subcutaneous Needling in Treating Soft Tissue Pain of Knee Osteoarthritis: A Randomized Clinical Trial. J Clin Med 2022; 11:jcm11237184. [PMID: 36498758 PMCID: PMC9740707 DOI: 10.3390/jcm11237184] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose: Fu’s subcutaneous needling (FSN) is a new acupuncture technique that produces a long-lasting effect in soft-tissue injuries. In patients with degenerative knee osteoarthritis (OA), myofascial trigger points (MTrPs) are common in the lower-limb muscles. In this randomized clinical trial, we evaluated the immediate, 1-week and 2-week effectiveness of FSN therapy in the treatment of degenerative knee OA. Patients and methods: We randomly divided 32 patients with knee OA into the FSN group (mean age: 65.73 ± 6.79 years) or the transcutaneous electrical nerve stimulation (TENS) group (mean age: 62.81 ± 5.72 years). The pressure pain threshold (PPT) and tissue hardness (TH) of the muscle and tendon attachment sites, knee range of motion, and physical ability (average walking speed) were measured. The subjective pain intensity index, Western Ontario and McMaster Universities OA Index (WOMAC), and Lequesne index were used to determine the efficacy of FSN on MTrP-induced soft-tissue pain compared with that of TENS. Results: A significantly greater improvement in pain qualities in the VAS (p < 0.05) was found in the FSN group. Moreover, in muscle and tendon qualities (including PPT and TH), a significant difference in the PPT of the quadriceps muscle (p < 0.05) was also observed among the immediate treatments in the FSN group. As for the functional index questionnaire assessment, the FSN group exhibited significant improvements among the immediate, 1-week and 2-week efficacies in terms of WOMAC (p < 0.05) and Lequesne index scores (p < 0.05). Conclusion: FSN was effective in treating soft-tissue pain in degenerative knee OA in terms of alleviating pain, strengthening walking ability, and improving overall functional performance. Pain relief was the primary benefit of FSN and a significant correlation between pain relief and knee joint mobility improvement was found. Trial registration: ClinicalTrials.gov Protocol Registration and Results System (registration number: NCT04356651).
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Post AA, Dailey DL, Bayman EO, Chimenti RL, Costigan M, Franck C, Huff T, Johnson E, Koepp M, Lafontant DE, McCabe ME, Neill-Hudson T, Vance CGT, Van Gorp B, Zimmerman BM, Ecklund D, Crofford LJ, Sluka KA. The Fibromyalgia Transcutaneous Electrical Nerve Stimulation in Physical Therapy Study Protocol: A Multisite Embedded Pragmatic Trial. Phys Ther 2022; 102:pzac116. [PMID: 36036838 PMCID: PMC10071449 DOI: 10.1093/ptj/pzac116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/01/2022] [Accepted: 08/01/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological intervention that provides an electrical current through the skin to produce analgesia. The primary purpose of this study is to examine if the addition of TENS to routine physical therapy improves movement-evoked pain in individuals with fibromyalgia in a physical therapy clinical setting. METHODS Fibromyalgia TENS in Physical Therapy Study is a phase III embedded pragmatic clinical trial funded through the National Institutes of Health Helping to End Addiction Long-Term Initiative. This trial will utilize a randomized cluster design that includes more than 110 physical therapists in 24 to 30 physical therapy clinics within 6 health care systems and 7 states. Clinics will be randomized to TENS or No-TENS, stratified by health care system and clinic size. The plan is to enroll 600 participants, with all participants completing physical therapy as prescribed by their physical therapist. Participants at TENS clinics will utilize TENS for a minimum of 2-hour per day while at the physical therapy clinic and at home when active. The primary outcome is reduction in movement-evoked pain from baseline to day 60 on an 11-point numeric rating scale when participants sit and stand 5 times (Sit and Stand Test). Secondary outcomes include resting pain and fatigue, pain interference, fibromyalgia disease activity, movement-evoked fatigue, multidimensional assessment of fatigue, rapid assessment of physical activity, patient global impression of change, and common data elements shared across studies supported through the Helping to End Addiction Long-Term Initiative. IMPACT The findings from this study will provide effectiveness data on TENS for individuals with fibromyalgia for health care policymakers, clinicians, and insurers. Data from this study will also inform future pragmatic trials for nonpharmacological interventions and chronic musculoskeletal pain conditions.
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Affiliation(s)
- Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
- Physical Therapy Department, St. Ambrose University, Davenport, Iowa, USA
| | - Emine O Bayman
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
- Department of Anesthesia, The University of Iowa, Iowa City, Iowa, USA
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Michele Costigan
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
| | - Carla Franck
- Kepros Physical Therapy, Cedar Rapids, Iowa, USA
| | - Trevis Huff
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
| | - Elizabeth Johnson
- Vanderbilt University Medical Center, Division of Rheumatology and Immunology, Nashville, Tennessee, USA
| | - Maxine Koepp
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
| | - David-Erick Lafontant
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Megan E McCabe
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
| | - Tina Neill-Hudson
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
| | - Carol G T Vance
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Barb Van Gorp
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Bridget M Zimmerman
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
| | - Dixie Ecklund
- The University of Iowa Clinical Trials Statistical and Data Management Center, Iowa City Iowa, USA
| | - Leslie J Crofford
- Vanderbilt University Medical Center, Division of Rheumatology and Immunology, Nashville, Tennessee, USA
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
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Formenti P, Piuri G, Bisatti R, Pinciroli R, Umbrello M. Role of acupuncture in critically ill patients: A systematic review. J Tradit Complement Med 2022; 13:62-71. [PMID: 36685071 PMCID: PMC9845654 DOI: 10.1016/j.jtcme.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/07/2022] Open
Abstract
Acupuncture is part of a complex medical approach used in China for about 2000 years, known as Traditional Chinese Medicine, whose central assumption is that health occurs when the patterned energy flow throughout the body is balanced. Within this paradigm, acute illness occurs when a major state of imbalance or disruption arises, and the use of acupuncture may help in correcting these imbalances. While the Chinese hospital system often offers the integration of traditional and western medicine, in Europe and the United States this combined approach is infrequently practiced. However, several investigations have consistently shown the effectiveness of acupuncture for different aspects of critical illness. The aim of this systematic review is to increase the clinician's awareness of the current evidence regarding the use of acupuncture for the management of critically ill patients, both alone or as a complement to western medicine. The effects of acupuncture on critical illness, with a particular focus on respiratory function, pain and delirium treatment and prevention, circulatory function, nutritional support, and recovery after acute illness are explored and summarized, and evidence is provided that acupuncture is an acceptable and feasible option for the management of several aspects of critical illness. In addition, we suggest a practical selection of potentially useful acupuncture points in the critical care setting, with indications for simple localization and the correct puncture method.
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Affiliation(s)
- Paolo Formenti
- SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
| | | | | | - Riccardo Pinciroli
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Michele Umbrello
- SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, Milan, Italy,Corresponding author. SC Anestesia e Rianimazione II, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo – Polo Universitario, 20151, Milano, Italy.
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Ferrillo M, Giudice A, Marotta N, Fortunato F, Di Venere D, Ammendolia A, Fiore P, de Sire A. Pain Management and Rehabilitation for Central Sensitization in Temporomandibular Disorders: A Comprehensive Review. Int J Mol Sci 2022; 23:12164. [PMID: 36293017 PMCID: PMC9602546 DOI: 10.3390/ijms232012164] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 11/24/2022] Open
Abstract
Temporomandibular disorders (TMD) are a group of musculoskeletal diseases affecting masticatory muscles and temporomandibular joints (TMJ). In this context, the chronic TMD could be considered as a condition with chronic primary orofacial pain, presenting as myofascial TMD pain or TMJ arthralgia. In this context, myogenous TMD may present overlapping features with other disorders, such as fibromyalgia and primary headaches, characterized by chronic primary pain related to dysfunction of the central nervous system (CNS), probably through the central sensitization. This phenomenon could be defined as an amplified response of the CNS to sensory stimuli and peripheral nociceptive, characterized by hyperexcitability in the dorsal horn neurons in the spinal cord, which ascend through the spinothalamic tract. The main objectives of the management of TMD patients are: decreasing pain, increasing TMJ function, and reducing the reflex masticatory muscle spasm/pain. The first-line treatments are physical therapy, pharmacological drugs, occlusal splints, laser therapy, extracorporeal shockwave therapy, transcutaneous electrical nerve stimulation, and oxygen-ozone therapy. Although all these therapeutic approaches were shown to have a positive impact on the central sensitization of TMD pain, there is still no agreement on this topic in the scientific literature. Thus, in this comprehensive review, we aimed at evaluating the evidence on pain management and rehabilitation for the central sensitization in TMD patients.
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Affiliation(s)
- Martina Ferrillo
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Amerigo Giudice
- Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Francesco Fortunato
- Institute of Neurology, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Pietro Fiore
- Neurological Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS Institute of Bari, 70124 Bari, Italy
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
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Xu S, Kim J, Walter JR, Ghaffari R, Rogers JA. Translational gaps and opportunities for medical wearables in digital health. Sci Transl Med 2022; 14:eabn6036. [PMID: 36223451 DOI: 10.1126/scitranslmed.abn6036] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
A confluence of advances in biosensor technologies, enhancements in health care delivery mechanisms, and improvements in machine learning, together with an increased awareness of remote patient monitoring, has accelerated the impact of digital health across nearly every medical discipline. Medical grade wearables-noninvasive, on-body sensors operating with clinical accuracy-will play an increasingly central role in medicine by providing continuous, cost-effective measurement and interpretation of physiological data relevant to patient status and disease trajectory, both inside and outside of established health care settings. Here, we review current digital health technologies and highlight critical gaps to clinical translation and adoption.
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Affiliation(s)
- Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Sibel Health, Niles, IL 60714, USA
| | - Joohee Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA
| | - Jessica R Walter
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Epicore Biosystems Inc., Cambridge, MA 02139, USA
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Kawamura H, Tsujishita M. Comparison of the effective intensity of transcutaneous electrical nerve stimulation contralateral to a pain site for analgesia. J Phys Ther Sci 2022; 34:704-709. [PMID: 36213189 PMCID: PMC9535248 DOI: 10.1589/jpts.34.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to compare the effectiveness of transcutaneous electrical nerve stimulation contralateral to the pain site for analgesia to identify the effective stimulation intensity. [Participants and Methods] Ten healthy adult females were recruited for the study. The same heat stimulation was applied to the left wrist joint of each participant to induce pain, serving as the control. Transcutaneous electrical nerve stimulation was then randomly administered to the right wrist, corresponding to the same dermatome contralateral to the painful site, at the intensities of comfortable stimulation, pain threshold, and maximum pain. The effect of transcutaneous electrical nerve stimulation was assessed using a Visual Analogue Scale and by analysis of heart rate variability. [Results] The Visual Analogue Scale score was significantly lower after stimulation with the maximum pain intensity than that for control, and there were no significant differences among the intensities of comfortable stimulation, pain threshold, and maximum pain. No significant differences were found among the groups in terms of high and low-to-high frequency components. [Conclusion] Transcutaneous electrical nerve stimulation at the maximum pain intensity to the dermatome area contralateral to that of the dorsal pain site of the left wrist was considered effective.
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Affiliation(s)
- Hirobumi Kawamura
- Department of Physical Therapy, Faculty of Nursing and
Rehabilitation, Konan Women’s University: 6-2-23 Morikita-machi, Higashinada-ku, Kobe
658-0001, Japan
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Vance CGT, Dailey DL, Chimenti RL, Van Gorp BJ, Crofford LJ, Sluka KA. Using TENS for Pain Control: Update on the State of the Evidence. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1332. [PMID: 36295493 PMCID: PMC9611192 DOI: 10.3390/medicina58101332] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention used in the treatment of acute and chronic pain conditions. The first clinical studies on TENS were published over 50 years ago, when effective parameters of stimulation were unclear and clinical trial design was in its infancy. Over the last two decades, a better understanding of the mechanisms underlying TENS efficacy has led to the development of an adequate dose and has improved outcome measure utilization. The continued uncertainty about the clinical efficacy of TENS to alleviate pain, despite years of research, is related to the quality of the clinical trials included in systematic reviews. This summary of the evidence includes only trials with pain as the primary outcome. The outcomes will be rated as positive (+), negative (-), undecided (U), or equivalent to other effective interventions (=). In comparison with our 2014 review, there appears to be improvement in adverse events and parameter reporting. Importantly, stimulation intensity has been documented as critical to therapeutic success. Examinations of the outcomes beyond resting pain, analgesic tolerance, and identification of TENS responders remain less studied areas of research. This literature review supports the conclusion that TENS may have efficacy for a variety of acute and chronic pain conditions, although the magnitude of the effect remains uncertain due to the low quality of existing literature. In order to provide information to individuals with pain and to clinicians treating those with pain, we suggest that resources for research should target larger, high-quality clinical trials including an adequate TENS dose and adequate timing of the outcome and should monitor risks of bias. Systematic reviews and meta-analyses should focus only on areas with sufficiently strong clinical trials that will result in adequate sample size.
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Affiliation(s)
- Carol G. T. Vance
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Dana L. Dailey
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
- Department of Physical Therapy, St. Ambrose University, Davenport, IA 52803, USA
| | - Ruth L. Chimenti
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Barbara J. Van Gorp
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
| | - Leslie J. Crofford
- Division of Rheumatology & Immunology, Medical Center, Vanderbilt University, Nashville, TN 37232, USA
| | - Kathleen A. Sluka
- Department of Physical Therapy and Rehabilitation Science Department, Roy J and Lucille A Carver College of Medicine, The University of Iowa, Iowa City, IA 52242, USA
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64
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Ezema CI, Onyeso OK, Nna EO, Awosoga OA, Odole AC, Kalu ME, Okoye GC. Transcutaneous electrical nerve stimulation effects on pain-intensity and endogenous opioids levels among chronic low-back pain patients: A randomised controlled trial. J Back Musculoskelet Rehabil 2022; 35:1053-1064. [PMID: 35253730 DOI: 10.3233/bmr-210146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) is a promising non-pharmacological modality for the management of chronic low back pain (CLBP), but its efficacy and mode of action have not been clearly established. OBJECTIVE To evaluate the responses of plasma beta-endorphin (βE), met-enkephalin (ME), and pain intensity (PI) among patients with CLBP exposed to TENS or sham-TENS. METHODS This double-blind trial involved 62 participants (aged 53.29 ± 5.07 years) randomised into TENS group (frequency 100 Hz, burst-rate 2 Hz, burst-width 150 μs, intensity 40 mA, duration 30 min), and sham-TENS group. The PI and plasma concentrations of βE and ME were measured at baseline, immediately (0 hr), 1 hr, 24 hrs, and 48 hrs post-intervention. Data were analysed using general linear model repeated measures, ordinal regression, one-way analysis of variance, Kruskal-Wallis test, independent and paired samples t-tests, Mann-Whitney U test, Wilcoxon signed-rank test, and Kendall's tau coefficient. RESULTS There was a significant temporal difference in PI between groups, F (1, 58) = 18.83, p< 0.001; the TENS group had better pain relief. The relative analgesic effect of TENS started immediately after the intervention (median difference [MD] =-3, p< 0.001), peaked at 1 hr (MD=-4, p< 0.001), and worn out by 24 hrs (MD=-1, p= 0.029). However, there was no significant difference in βE and ME between the groups from 0 hr to 24 hrs post interventions, and no significant correlation between the PI, and βE, or ME. CONCLUSION TENS significantly reduced PI up to 24 hrs after treatment.
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Affiliation(s)
- Charles Ikechukwu Ezema
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ogochukwu Kelechi Onyeso
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria.,Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada.,Emerging Researchers and Professionals in Ageing-African Network, Nigeria
| | | | | | - Adesola Christiana Odole
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Michael Ebe Kalu
- Emerging Researchers and Professionals in Ageing-African Network, Nigeria.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Goddy Chuba Okoye
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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65
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Maris S, Brands M, Lenskens D, Braeken G, Kemnitz S, Vanhove H, Mc Laughlin M, Meesen R, Brône B, Stessel B. Transcutaneous electrical nerve inhibition using medium frequency alternating current. Sci Rep 2022; 12:14911. [PMID: 36050354 PMCID: PMC9437086 DOI: 10.1038/s41598-022-18974-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Transcutaneous medium-frequency alternating electrical current is defined as an alternating current between 1 and 10 kHz and is capable of producing an instant, reversible block. This study aims to evaluate the efficacy of sensory perception and force production of the index and middle finger after transcutaneous medium-frequency alternating electrical current stimulation of the distal median nerve. A single-center prospective interventional cohort study was conducted in adult healthy volunteers at the Jessa Hospital, Hasselt, Belgium. Two different electrodes (PALS & 3M) were placed on the distal median nerve, which was located using a Sonosite X-Porte Ultrasound transducer, with the first electrode being placed on the skin at the level of the transverse carpal ligament and the second electrode 7 cm proximally to the first electrode. The tactile sensation was evaluated with Semmes–Weinstein monofilament test and sensation of pressure/pain was evaluated with an algometer. Peak force production was assessed with an electronic dynamometer. All measurements were performed at baseline and tMFAEC stimulation frequencies of 2 and 10 kHz in a randomized manner. Statistical analysis was performed with a one-way ANOVA with repeated measures test or a Friedman rank sum test, followed by the Wilcoxon signed rank test adjusted with Bonferroni correction. A p-value < 0.05 was considered statistically significant. From 9 to 13th of April 2021, 25 healthy volunteers were included in the Jessa Hospital, Hasselt, Belgium. A statistically significant reduction in tactile sensation during 2 kHz and 10 kHz stimulation compared to baseline was observed (2.89 ± 0.22 (PALS2); 3.35 ± 0.25 (3M2) and 2.14 ± 0.12 (PALS10); 2.38 ± 0.12 (3M10) versus − 1.75 ± 0.09 (baseline), p < 0.0001). 3M electrodes showed a tendency towards the elevation of pressure pain threshold compared to baseline. No significant difference in mean peak forces of the index and middle fingers after transcutaneous medium-frequency alternating electrical current stimulation with 2 and 10 kHz was found. This study demonstrates that transcutaneous medium-frequency alternating electrical current stimulation on the distal median nerve inhibits tactile sensory nerve activity in the index and middle finger when stimulation of 2 kHz and, to a lesser extent, 10 kHz was applied. A reduction of motor nerve activity was not observed but force production measurements may be prone to error. Trial registration: clinicaltrials.gov on 01/04/2021. NCT-Number: NCT04827173.
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Affiliation(s)
- Seppe Maris
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium. .,Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium.
| | - Michiel Brands
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Daniele Lenskens
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.,Department of Anaesthesiology and Pain Medicine, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Geert Braeken
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium
| | - Stefan Kemnitz
- Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium
| | - Herbert Vanhove
- Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium
| | - Myles Mc Laughlin
- Exp ORL, Department of Neurosciences, The Leuven Brain Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Raf Meesen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Agoralaan Gebouw A, 3590, Diepenbeek, Belgium.,Movement Control and Neuroplasticity Research Group, Group Biomedical Sciences, Department of Movement Sciences, KU Leuven, Herestraat 49, 3500, Leuven, Belgium
| | - Bert Brône
- Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium
| | - Björn Stessel
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, 3500, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, BIOMED Research Institute, UHasselt, Agoralaan Gebouw C, 3590, Diepenbeek, Belgium
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66
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Nishi Y, Ikuno K, Minamikawa Y, Igawa Y, Osumi M, Morioka S. A novel form of transcutaneous electrical nerve stimulation for the reduction of dysesthesias caused by spinal nerve dysfunction: A case series. Front Hum Neurosci 2022; 16:937319. [PMID: 36092646 PMCID: PMC9449584 DOI: 10.3389/fnhum.2022.937319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Current therapeutic interventions for dysesthesias caused by spinal cord dysfunctions are ineffective. We propose a novel intervention using transcutaneous electrical nerve stimulation (TENS) for dysesthesias, and we present an in-depth case series. Patients and methods Conventional high-frequency TENS and the novel dysesthesia-matched TENS (DM-TENS) were applied to 16 hands of nine patients with spinal cord dysfunction. The dysesthesia-matched TENS’ stimulus intensity and frequency matched the intensity and somatosensory profile of the patients’ dysesthesias. The Short-Form McGill Pain Questionnaire version-2 (SF-MPQ2) and quantitative sensory testing (QST) were applied during electrical stimulation/no stimulation. We determined intraclass correlation coefficients (ICCs) to evaluate the reliability of the setting and the effects on the dysesthesias and the change in subjective dysesthesia between each patient’s baseline without TENS and DM-TENS. Results We were able to apply electrical stimulation matching the patients’ subjective dysesthesia for 14 hands (eight patients). TENS could not be applied for the remaining patient due to severe sensory deficits. Compared to the patients’ baseline and high-frequency TENS, the DM-TENS provided significant decreases in tingling/pins-and-needles and numbness on the SF-MPQ2, and it significantly improved the dynamic and static mechanical detection on QST. Regarding the reliability of the dysesthesia-matched TENS settings, the ICCs (1,5) were intensity, 0.95; frequency, 1.00; and effect on dysesthesia, 0.98. Conclusion DM-TENS improved the dysesthesias and mechanical hypoesthesia caused by spinal cord dysfunction. The effectiveness of DM-TENS particularly for tingling and numbness was clearly higher and was reliable within the patients. These results may suggest an effective treatment of dysesthesias in patients with spinal cord dysfunction. Clinical trial registration [https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000045332], identifier [UMIN000045332].
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Affiliation(s)
- Yuki Nishi
- Institute of Biomedical Sciences (Health Sciences), Nagasaki University, Nagasaki, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- *Correspondence: Yuki Nishi,
| | - Koki Ikuno
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Yuji Minamikawa
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Yuki Igawa
- Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan
- Graduate School of Health Science, Kio University, Nara, Japan
- Shu Morioka,
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67
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Gnasso R, Corrado B, Iommazzo I, Migliore F, Magliulo G, Giardulli B, Ruosi C. Assessment, pharmacological therapy and rehabilitation management of musculoskeletal pain in children with mucopolysaccharidoses: a scoping review. Orphanet J Rare Dis 2022; 17:255. [PMID: 35804400 PMCID: PMC9264657 DOI: 10.1186/s13023-022-02402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pain of musculoskeletal origin is very common in young patients affected by Mucopolysaccharidoses. This scoping review evaluates the evidence for assessment, pharmacological treatment and rehabilitation management for musculoskeletal pain of the latter. Methods A Medline search through PubMed has been performed for studies published in English at least for the past twenty years. Two investigators independently reviewed all search results and extracted those that met the inclusion criteria. Results 29 studies have been selected and analysed in depth, of which 10 related to pain assessment, 11 concerned pharmacological approach, and 8 reported rehabilitation approaches. Conclusion Few data are available in literature concerning the classification and management of pain in children with Mucopolysaccharidoses. Notwithstanding, pain evaluation methods are effectively used to classify pain intensity, according to the age group and communication abilities of young Mucopolysaccharidoses patients. The review emphasizes that drug therapies have a palliative purpose, while rehabilitation reduces musculoskeletal pain and can provide a therapeutic effect on disabilities.
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Affiliation(s)
- R Gnasso
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy.
| | - B Corrado
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - I Iommazzo
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - F Migliore
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - G Magliulo
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - B Giardulli
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - C Ruosi
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
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68
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Rezende LFD, Da Silva Costa EC, Lenzi J, Carvalho RL, Vilas Boas VF. Transcutaneous Electrical Stimulation, Interferential Current and Photobiomodulation May Lead to the Recurrence of Breast Cancer in Rats? REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Introduction: Transcutaneous electrical nerve stimulation (TENS), interferential current therapy (IFC) and photobiomodulation therapy (PBMT) have been used in the management of cancer-related pain in adults. However, there are still some controversy regarding the effects of this therapy on tumor cells that may remain after cancer treatment. Objective: To evaluate the risk of recurrence of breast cancer in rats when using TENS, IFC or PBMT. Method: An experimental, randomized, controlled and cross-sectional study. With 90 days of age, 7,12-dimetylbenz(a)anthracene (7,12-DMBA) was administered to rats by gastric gavage to induce mammary cancer. After 120 days the mammary glands of the rats belonging to the group with mammary cancer were removed. Results: 39 female Sprague-Dawley rats were studied: 9 rats without induction of mammary carcinoma; 9 rats with induction of mammary carcinoma and without surgery; 9 rats with induction of mammary carcinoma with surgery and placebo application of TENS, IFC, PBMT; 9 rats with induction of mammary carcinoma, surgery and the application of TENS, IFC and PBMT. Conclusion: This study demonstrated that there was local recurrence of tumors in rats that were stimulated with TENS or IFC, however no evidence of local recurrence with PBMT.
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69
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Dailey DL, Vance CGT, Chimenti R, Rakel BA, Zimmerman MB, Williams JM, Sluka KA, Crofford LJ. The Influence of Opioids on Transcutaneous Electrical Nerve Stimulation Effects in Women With Fibromyalgia. THE JOURNAL OF PAIN 2022; 23:1268-1281. [PMID: 35292378 DOI: 10.1016/j.jpain.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/28/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Transcutaneous electrical nerve stimulation (TENS) uses endogenous opioids to produce analgesia, and effectiveness can be reduced in opioid-tolerant individuals'. We examined TENS effectiveness (primary aim), and differences in fibromyalgia symptoms (secondary aim), in women with fibromyalgia regularly taking opioid (RTO) medications compared with women not- regularly taking opioids (not-RTO). Women (RTO n = 79; not-RTO not-n = 222) with fibromyalgia with daily pain levels ≥4 were enrolled and categorized into RTO (taking opioids at least 5 of 7 days in last 30 days) or not-RTO groups. Participants were categorized into tramadol n = 52 (65.8%) and other opioids n = 27 (34.2%) for the RTO group. Participants were phenotyped across multiple domains including demographics, fibromyalgia characteristics pain, fatigue, sleep, psychosocial factors, and activity. Participants were randomized to active TENS (n = 101), placebo TENS (n = 99), or no TENS (n = 99) for 1-month with randomization stratified by opioid use. Active TENS was equally effective in movement-evoked pain in those in the RTO and not-RTO groups. Women with fibromyalgia in the RTO group were older (P = .002), lower-income (P = .035), more likely to smoke (P = .014), and more likely to report depression (P = .013), hypertension (P = .005) or osteoarthritis (P = .027). The RTO group demonstrated greater bodily pain on SF-36 (P = .005), lower quality of life on the physical health component of the SF-36 (P = .040), and greater fatigue (MAF-ADL P = .047; fatigue with sit to stand test (P = .047) These differences were small of and unclear clinical significance. In summary, regular use of opioid analgesics does not interfere with the effectiveness of TENS for movement-evoked pain. Clinical Trial Registration Number: NCT01888640. PERSPECTIVE: Individuals treated with mixed frequency TENS at a strong but comfortable intensity that was taking prescription opioid analgesics showed a significant reduction in movement-evoked pain and fatigue. These data support the use of TENS, using appropriate parameters of stimulation, as an intervention for individuals with fibromyalgia taking opioid analgesics.
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Affiliation(s)
- Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; Department of Physical Therapy St. Ambrose University, Davenport, Iowa.
| | - Carol G T Vance
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Ruth Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa
| | - Barbara A Rakel
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; College of Nursing, University of Iowa, Iowa City, Iowa
| | | | - Jon M Williams
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, Tennessee
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, Iowa; College of Nursing, University of Iowa, Iowa City, Iowa
| | - Leslie J Crofford
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, Tennessee
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Lee HJ, Hong JK, Choi H, Chung S, Yoon IY. Age-Limited Effects of Low-Frequency Transcutaneous Electric Nerve Stimulation on Insomnia: A 4-Week Multi-Center, Randomized Controlled Study. Psychiatry Investig 2022; 19:451-461. [PMID: 35753684 PMCID: PMC9233949 DOI: 10.30773/pi.2021.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Insomnia disorder is a common condition with considerable harmful effects on health. We investigated the therapeutic efficacy and safety of low-frequency transcutaneous electric nerve stimulation (LF-TENS) as an alternative treatment option for insomnia disorder. METHODS A 4-week, multi-center, randomized controlled study was conducted. A total of 160 individuals aged 40 to 80 years with insomnia disorder were included and randomized to the experimental group receiving active device (n=81) or control group receiving sham device (n=79). Both groups used the device for four weeks, more than five days a week. The participants also completed pre- and post-intervention assessment with questionnaires, sleep diaries, wrist actigraphy, and blood tests. RESULTS There was no significant between-group difference in the changes of mood and sleep parameters and blood test results among the two study groups. Meanwhile, in the exploratory sub-group analysis of patients aged over 60 years, the experimental group showed better improvement after intervention in the change of Pittsburgh Sleep Quality Index (PSQI) score (-2.63±3.25 vs. -1.20±2.28, p=0.039; Cohen's d=0.99 vs. 0.45) and blood cortisol level (-1.65±3.37 μg/dL vs. -0.16±3.49 μg/dL, p=0.007; Cohen's d=0.56 vs. 0.05). In addition, no serious adverse reaction occurred during the study period in both groups. CONCLUSION The effect of LF-TENS was limited to older patients aged over 60 years, which might be related to the modulation of hypothalamic-pituitary-adrenal axis activity.
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Affiliation(s)
- Hyuk Joo Lee
- Department of Public Medical Service, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Kyung Hong
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hayun Choi
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Young Yoon
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
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It Hurts to Move! Intervention Effects and Assessment Methods for Movement-Evoked Pain in Patients With Musculoskeletal Pain: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther 2022; 52:345-374. [PMID: 35128943 DOI: 10.2519/jospt.2022.10527] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To estimate the effects of musculoskeletal rehabilitation interventions on movementevoked pain and to explore the assessment methods/protocols used to evaluate movement-evoked pain in adults with musculoskeletal pain. DESIGN Systematic review with meta-analysis. LITERATURE SEARCH Three electronic databases (PubMed, Web of Science, and Scopus) were searched. STUDY SELECTION CRITERIA Randomized controlled trials investigating musculoskeletal rehabilitation interventions for movement-evoked pain in adults with musculoskeletal pain were included. DATA SYNTHESIS Meta-analysis was conducted for outcomes with homogeneous data from at least 2 trials. The mean change in movementevoked pain was the primary outcome measure. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS Thirty-eight trials were included, and 60 different interventions were assessed. There was moderate-certainty evidence of a beneficial effect of exercise therapy compared to no treatment (standardized mean difference [SMD], -0.65; 95% confidence interval [CI]: -0.83, -0.47; P<.001) on movement-evoked pain in adults with musculoskeletal pain. There was low-certainty evidence of a beneficial effect of transcutaneous electrical nerve stimulation compared to no treatment (SMD, -0.46; 95% CI: -0.71, -0.21; P = .0004). There was no benefit of transcutaneous electrical nerve stimulation when compared to sham transcutaneous electrical nerve stimulation (SMD, -0.28; 95% CI: -0.60, 0.05; P = .09; moderate-certainty evidence). CONCLUSION There was moderate-certainty evidence that exercise therapy is effective for reducing movement-evoked pain in patients with musculoskeletal pain compared to no treatment. Consider exercise therapy as the first-choice treatment for movement-evoked pain in clinical practice. J Orthop Sports Phys Ther 2022;52(6):345-374. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10527.
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Parseliunas A, Paskauskas S, Simatoniene V, Kubiliute E, Dainius E, Subocius A, Venclauskas L, Venskutonis D. Transcutaneous Electric Nerve Stimulation Reduces Pathological Sensation of Mesh One Week after Open Inguinal Hernia Surgery: Follow-Up Results from a Randomized, Double Blind and Placebo-Controlled Trial. Medicina (B Aires) 2022; 58:medicina58060725. [PMID: 35743988 PMCID: PMC9228604 DOI: 10.3390/medicina58060725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Quality of life (QoL) and chronic pain are important outcomes following hernia surgery. The long-term effects of Transcutaneous Electric Nerve Stimulation (TENS) on postoperative recovery are not well known. In this trial we investigated the role of TENS on QoL and on the incidence of chronic pain following inguinal hernia repair with mesh. Materials and Methods: A total of 80 male patients with elective primary unilateral hernia Lichtenstein repair were randomly allocated to receive TENS or a placebo-TENS procedure. The TENS group received conventional TENS twice a day on the first and second postoperative days. The intensity was set at 0–0.5 mA in the placebo-TENS group. General and hernia-specific QoL, as well as the incidence of chronic pain were assessed using SF-36v2 and the Carolinas comfort scale. Results: Less sensation of mesh was reported by the TENS group patients one week after surgery. At this time point, the mean sensation score was 6.07 ± 8.88 in the TENS group and 14.08 ± 16.67 in the placebo-TENS group (p = 0.029). Although at two days and one week postoperatively, TENS group patients tended to have less pain, less movement restrictions and better overall hernia-specific QoL, the differences were not statistically significant. At 6 months postoperatively, no incidence of chronic pain was found in either the placebo-TENS or TENS group. Conclusions: Conventional TENS applied in the early postoperative period following inguinal hernia repair with mesh was found to reduce mesh-related foreign body sensation one week after surgery. Promising results were also found for other QoL domains.
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Affiliation(s)
- Audrius Parseliunas
- Department of General Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.K.); (E.D.); (A.S.); (D.V.)
- Correspondence: ; Tel.: +370-37-306059
| | - Saulius Paskauskas
- Department of Obstetrics and Gynecology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Violeta Simatoniene
- Department of Physics, Mathematics and Biophysics, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Egle Kubiliute
- Department of General Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.K.); (E.D.); (A.S.); (D.V.)
| | - Edvinas Dainius
- Department of General Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.K.); (E.D.); (A.S.); (D.V.)
| | - Andrejus Subocius
- Department of General Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.K.); (E.D.); (A.S.); (D.V.)
| | - Linas Venclauskas
- Department of Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Donatas Venskutonis
- Department of General Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.K.); (E.D.); (A.S.); (D.V.)
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Castro-Sánchez AM, Antequera-Soler E, Matarán-Peñarrocha GA, Hurley DA, Martínez-de la Cal J, García-López H, Capel-Alcaraz AM, Lara-Palomo IC. Comparing an e-Health program vs home rehabilitation program in patients with non-specific low back pain: A study protocol randomized feasibility trial. J Back Musculoskelet Rehabil 2022; 35:239-252. [PMID: 34308900 DOI: 10.3233/bmr-210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is little evidence on the reliability of the web application-based rehabilitation systems to treat chronic low back pain (CLBP). METHODS This protocol describes a double-blind, randomized controlled feasibility trial of an e-Health intervention developed to support the self-management of people with CLBP in primary care physiotherapy. Three Hospitals with primary care for outpatients will be the units of randomisation, in each Hospital the participants will be randomized to one of two groups, a pragmatic control group receiving either the usual home program based on electrostimulation and McKenzie Therapy and e-Health intervention. Patients are followed up at 2 and 6 months. The primary outcomes are (1) acceptability and demand of the intervention by GPs, physiotherapists and patients and (2) feasibility and optimal study design/methods for a definitive trial. Secondary outcomes will include analysis in the clinical outcomes of pain, disability, fear of movement, quality of life, isometric resistance of the trunk flexors, lumbar anteflexion and lumbar segmental range of motion. DISCUSSION The specific e-Health programs to home could increase adherence to treatment, prevent stages of greater pain and disability, and improve the painful symptomatology. CONCLUSIONS The e-Health programs could be an effective healthcare tool that can reach a large number of people living in rural or remote areas.
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Affiliation(s)
| | | | | | - Deirdre A Hurley
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland
| | | | - Héctor García-López
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Spain
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Inglese A, Santandrea S. Post-arthrolysis rehabilitation in a patient with wrist stiffness secondary to distal radio-ulnar fracture: A case report. Physiother Theory Pract 2022:1-15. [PMID: 35272585 DOI: 10.1080/09593985.2022.2045657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Arthrolysis is usually performed when stiffness has a disabling effect on quality of life and in cases where physiotherapy has not been effective. This report describes one patient with a chronic stiff wrist who underwent open arthrolysis. The purpose of this case report is to describe the rehabilitation following arthrolysis, in order to illustrate the effects of intensive physiotherapy for this patient. CASE DESCRIPTION A 54-year-old woman with chronic wrist stiffness secondary to a radio-ulnar fracture was described. The patient presented severe pain and unsatisfactory wrist range of motion and muscle strength almost 2 years after the traumatic event. INTERVENTION Post-arthrolysis rehabilitation was based on edema control, manual therapy, transcutaneous electrical nerve stimulation (TENS), static splinting and strengthening exercises. In addition, graded motor imagery and proprioceptive rehabilitation were included to address impaired motor control. Outcome measures of passive range of motion (PROM), active range of motion (AROM), grip and pinch strength, numeric rating scale (NRS), disability of the arm, shoulder and hand (DASH) and patient-rated wrist/hand evaluation (PRWHE) were recorded. CONCLUSIONS The outcomes of this case report suggest that arthrolysis combined with immediate and intensive physiotherapy were a suitable option for the treatment of post-traumatic wrist stiffness in this patient. The passive motion measured intraoperatively was maintained, while pain, functional active motion and strength were improved allowing for social reintegration.
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Affiliation(s)
- Andrea Inglese
- Poliambulatorio Shoulder Team, viale Andrea Costa 33, 47122 Forlì, Italy
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Physical therapy versus radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome: A randomized-controlled study. Turk J Phys Med Rehabil 2022; 68:126-135. [PMID: 35949973 PMCID: PMC9305635 DOI: 10.5606/tftrd.2022.7187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: This study aims to compare the efficacy of physical therapy (PT) and radial extracorporeal shock wave therapy (rESWT) in the treatment of carpal tunnel syndrome (CTS).
Patients and methods: Between May 2020 and July 2020, a total of 125 wrists of 95 patients (22 males, 73 females; mean age: 54.3±11.3 years; range, 19 to 69 years) with mild-to-moderate CTS were allocated into three groups and evaluated. The control group (Group 1, n=42) was treated with splinting and an exercise program. Group 2 (n=42) was treated with a total of three sessions of rESWT, splinting and an exercise program. Group 3 (n=41) was treated with a total of 15 sessions of PT modalities, splinting, and an exercise program. Each patient was evaluated before, three weeks and 12 weeks after treatment using a Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale, and electrodiagnostic testing.
Results: The reduction in VAS, BCTQ, LANSS, and improvement in sensory nerve conduction velocity were significantly greater at three and 12 weeks of follow-up in Groups 2 and 3, compared to Group 1 (p<0.001). A greater improvement was observed in all clinical parameters in Group 2, compared to Group 3 (p<0.001).
Conclusion: This is the first study to compare the treatment outcomes of PT and rESWT in the treatment of CTS. The results of this study show that both PT and rESWT are effective in the treatment of CTS; however, rESWT yields superior treatment effects compared to conventional PT. The practicalities of administering rESWT and its efficacy in the treatment of CTS may make it the treatment of choice.
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Buprenorphine, a partial opioid agonist, prevents modulation of H-reflex induced by pulsed electromagnetic stimulation in spinal cord injured rats. Neurosci Lett 2022; 777:136583. [DOI: 10.1016/j.neulet.2022.136583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/24/2022]
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Reduction on Proinflammatory Cytokines after Application of Transcutaneous Electrical Nerve Stimulation (TENS) in Patients with a Breast Cancer: A Nonrandomized, Open, and Single-Arm Study Protocol with Paired Analysis. Mediators Inflamm 2022; 2022:1350813. [PMID: 35241969 PMCID: PMC8886802 DOI: 10.1155/2022/1350813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/15/2021] [Accepted: 01/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Transcutaneous electrical nerve stimulation (TENS) has been used as analgesic therapy in many diseases. It is already known that studies that have observed the relationship between pain and cytokines have found that patients who report less severe pain have less production of proinflammatory cytokines. However, one another accepted mechanism is that decreasing proinflammatory cytokines results in decreased pain intensity. Analyzing the literature, the authors describe that, in addition to the analgesic effect, TENS has shown systemic effects, and clinically, the reduction of proinflammatory cytokines could be a protective factor against inflammation. To test the inflammatory effect of TENS, we researched the literature for clinical conditions that suggest that proinflammatory cytokines are one of the main mediators of the disease process. Chronic inflammation is one of the risk factors mentioned for the development of a new cancer; at the same time, it is indicated as an indicator of the worst prognosis. Studies also suggest that the worst prognosis of breast cancer, one of the types with the highest incidence in the world, may be related to increased inflammatory activity. Considering that inflammation is increased in breast cancer and that TENS can reduce proinflammatory cytokines even without blocking the pain pathway, our hypothesis is that the anti-inflammatory effect of TENS can bring benefits to these patients. The aim of this study will be to evaluate the effect of TENS on blood reduction of proinflammatory cytokines in breast cancer patients. Methods. This study will evaluate at least 59 patients, over 18 years of age, diagnosed with breast cancer, but who have not yet started any treatment. All patients will be submitted to TENS intervention (Ibramed, Model Neurodyn III, parameters: VIF—turn on, frequency—2-247 Hz, pulse size—50-500 μs, and intensity (mA)—maximum tolerated by the patient), and the data will be analyzed in the pre- and postintervention of each patient. The application has a total duration of 30 minutes, and 8 ml of blood will be collected before and after the intervention. Proinflammatory (IL-1, IL-2, IL-6, IL-7, and TNF-α) and anti-inflammatory (IL-4, IL-10, IL-13, and FTCβ) cytokines will be analyzed. As a primary endpoint, we will analyze the reduction in blood concentration of proinflammatory cytokines, and as secondary endpoints, we will analyze the size of the effect according to each type of proinflammatory cytokine, describe the effect size of the reduction according to the breast cancer immunohistochemistry, and analyze the effect of TENS on anti-inflammatory cytokines. This study is approved by the Research Ethics Committee (Centro Universitário FMABC, Brazil) and registered in the Brazilian Clinical Trials (Search text: RBR-10jbwh47).
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Hiraga Y, Babazono A, Hara R, Nomiyama K, Hirakawa Y. Rehabilitation interventions incorporating self-management improve psychological factors: A non-randomized controlled trial of patients after total Knee arthroplasty. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2033468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Yuki Hiraga
- Department of Occupational Therapy, Faculty of Health Science, International University of Health and Welfare, Okawa, Japan
- Department of Health Sciences, International University of Health and Welfare Graduate School, Okawa, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Kyushu University, Fukuoka, Japan
| | - Ryusei Hara
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka, Japan
| | - Katsuhiro Nomiyama
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka, Japan
| | - Yoshiyuki Hirakawa
- Department of Rehabilitation, Fukuoka Rehabilitation Hospital, Fukuoka, Japan
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Compton P, St Marie B. Coexisting Substance Use Disorder and Chronic Pain During COVID-19. Pain Manag Nurs 2022; 23:17-25. [PMID: 34620549 PMCID: PMC8418911 DOI: 10.1016/j.pmn.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/29/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Peggy Compton
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, 19104-4217.
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Samaras P, Karanasios S, Stasinopoulos D, Gioftsos G. Greek physiotherapists' contemporary knowledge and practice for lateral elbow tendinopathy: An online survey. Musculoskelet Sci Pract 2022; 57:102502. [PMID: 35030537 DOI: 10.1016/j.msksp.2022.102502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/30/2021] [Accepted: 01/03/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate physiotherapists' current knowledge and practice in the management of patients with lateral elbow tendinopathy, to explore associations between the participants' education and management preferences and to identify potential evidence-to-practice gaps by making comparisons with recent research recommendations. DESIGN An on-line cross-sectional survey. SUBJECTS Registered physiotherapists working in Greece with previous experience in the management of lateral elbow tendinopathy. RESULTS Three hundred and seventy eight responses met the inclusion criteria. Most responders (70.4%-91.5%) use pain provocation tests for the diagnosis of the condition, while a limited proportion uses patient rated outcome measures (6.9%-13%). Supervised exercise is the mainstay of rehabilitation (92.6%), followed by adjunctive research recommended treatment techniques such as manual therapy (72%) and advice (59.5%). Up to 83.6% of participants use adjunctive treatment techniques that are not recommended or without research recommendation (such as electrophysical agents, ice etc.). Physiotherapists with post-graduate education in musculoskeletal physiotherapy are almost three times more likely to choose only research recommended treatment approaches. There is a lack of consensus in an optimal exercise programme (type, volume, duration etc.) in patients with lateral elbow tendinopathy. CONCLUSION Despite research recommendations a limited use of patient rated outcome measures in lateral elbow tendinopathy is recorded. Supervised exercise is the first line treatment option for most physiotherapists, although the optimal application is still unclear. A large proportion of physiotherapists apply adjunctive treatment techniques that are either ineffective or poorly researched suggesting a substantial evidence-to-practice gap. Better access to knowledge, organisational and peer-support can potentially help to bridge this gap.
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Affiliation(s)
| | - Stefanos Karanasios
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Greece
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Neuromuscular & Cardiovascular Study of Motion (LANECASM), School of Health and Care Sciences, University of West Attica, Greece
| | - George Gioftsos
- Department of Physiotherapy, University of West Attica, Greece; Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Greece
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Al-Zamil M, Minenko IA, Kulikova NG, Alade M, Petrova MM, Pronina EA, Romanova IV, Narodova EA, Nasyrova RF, Shnayder NA. Clinical Experience of High Frequency and Low Frequency TENS in Treatment of Diabetic Neuropathic Pain in Russia. Healthcare (Basel) 2022; 10:healthcare10020250. [PMID: 35206866 PMCID: PMC8871830 DOI: 10.3390/healthcare10020250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 01/20/2023] Open
Abstract
Background: Transcutaneous electrical nerve stimulation (TENS) is presently one of the main methods of treatment for neuropathic pain in type II diabetes mellitus. The discussion about which TENS frequency is more effective in the treatment of neuropathic pain has been ongoing for many years. Despite this, the response of different aspects of neuropathic pain to various TENS modalities has not been sufficiently studied. Aim: To analyze changes in characteristics of neuropathic pain depending on the frequency of TENS. Materials and methods: Seventy-five Russian diabetic patients with painful distal axonal neuropathy were enrolled in the study. Patients were assigned to three groups: in the HF TENS group, 25 patients received standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin) + high-frequency TENS (HF); in the LF TENS group, 25 patients received standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin) + low-frequency TENS (LF); in the control group, 25 patients underwent just standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin). Pain intensity was calculated before and after treatment with visual analogue scale (VAS), McGill pain questionnaire (MPQ), Douleur Neuropathique 4 Questions (DN4) and Pain Drawing. Results: TENS increased the therapeutic effect of standard drug therapy, in the treatment of neuropathic pain, by 65.9% and prolonged its efficacy by 31% for up to 6 months after treatment. HF TENS had a more pronounced analgesic effect than LF TENS based on VAS (34.7%), sensory (57.6%) MPQ dimensions and DN4 (21%). Affective MPQ dimension with the use of LF TENS was lower than HF TENS by 34.7% immediately after treatment, by 47.3% after 2 months and by 34.8% after 6 months of the follow-up period. Conclusion: There are significant differences between HF and LF TENS based on pain assessment using various pain scales. This reflects the distinctive effects of different TENS modalities on different aspects of neuropathic pain.
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Affiliation(s)
- Mustafa Al-Zamil
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia;
- Correspondence: (M.A.-Z.); (N.A.S.); Tel.: +7-(812)-670-02-20 (M.A.-Z. & N.A.S.)
| | - Inessa A. Minenko
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University, 119435 Moscow, Russia;
| | - Natalia G. Kulikova
- Department of Physiotherapy, Faculty of Continuing Medical Education, Peoples’ Friendship University of Russia, 117198 Moscow, Russia;
| | | | - Marina M. Petrova
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
| | - Elena A. Pronina
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
| | - Irina V. Romanova
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
| | - Ekaterina A. Narodova
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
| | - Regina F. Nasyrova
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia;
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, 443099 Samara, Russia
| | - Natalia A. Shnayder
- Shared Core Facilities “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (E.A.P.); (I.V.R.); (E.A.N.)
- Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Medical Research Centre for Psychiatry and Neurology, 192019 Saint Petersburg, Russia;
- Correspondence: (M.A.-Z.); (N.A.S.); Tel.: +7-(812)-670-02-20 (M.A.-Z. & N.A.S.)
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Maheu E, Soriot-Thomas S, Noel E, Ganry H, Lespessailles E, Cortet B. Wearable transcutaneous electrical nerve stimulation (actiTENS®) is effective and safe for the treatment of knee osteoarthritis pain: a randomized controlled trial versus weak opioids. Ther Adv Musculoskelet Dis 2022; 14:1759720X211066233. [PMID: 35069809 PMCID: PMC8777341 DOI: 10.1177/1759720x211066233] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/15/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Despite their poor tolerance, especially in the elderly, weak opioids (WO) remain commonly prescribed for patients with knee osteoarthritis (KOA). We compared the efficacy and safety of a new wearable transcutaneous electrical nerve stimulation (W-TENS) device with WO for the treatment of moderate-to-severe, nociceptive KOA chronic pain. METHODS The study was a non-inferiority, multicentric, prospective, randomized, single-blind, controlled, 2-parallel groups Trial. A total of 110 patients with KOA were included (Kellgren-Lawrence radiographic grade ⩾2; American College of Rheumatology criteria), with chronic moderate-to-severe nociceptive pain (mean 8-day pain intensity (PI) ⩾ 4 on an 11-point numerical rating scale), in failure to non-opioid analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs). Patients with neuropathic pain were excluded. The co-primary endpoints were mean PI at 3 months (M3) and number of potentially treatment-related adverse events (TRAEs). Secondary outcomes included Western Ontario MAC Master University function subscale (range, 0-68), additional pain and quality of life measures, and responder rates. RESULTS The non-inferiority of W-TENS was demonstrated in both the per protocol (PP) and intent-to-treat (ITT) populations. At M3, PI in PP population was 3.87 (2.12) compared with 4.66 (2.37) [delta: -0.79 (0.44); 95% CI (-1.65, 0.08)] in W-TENS and WO groups, respectively. A planned superiority analysis showed a significant superiority of W-TENS over WO on PI at M3 (p = 0.0124). The number of TRAEs was significantly lower in the W-TENS group (n = 7) than in the WO group (n = 36) (p < 0.001). Other secondary outcomes also favored W-TENS. CONCLUSION W-TENS was more effective and better tolerated than WO in the treatment of chronic nociceptive KOA pain and offers an interesting non-pharmacological analgesic alternative in the management of KOA.Trial Registration: ClinicalTrials.gov: NCT03902340.
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Affiliation(s)
- Emmanuel Maheu
- Rheumatology Department, St-Antoine Hospital-APHP, 75011 Paris, FrancePrivate Office, 283, Bd Voltaire, Paris, France
| | - Sandrine Soriot-Thomas
- Clinical Research Centre and Orthopaedic and Traumatology Surgery Department, CHU Amiens Picardie, Amiens, France
| | - Eric Noel
- Rheumatologist, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - Eric Lespessailles
- Rheumatology Department, Regional Hospital of Orleans, University of Orléans, Orléans, France
| | - Bernard Cortet
- Department of Rheumatology, Centre Hospitalier Universitaire de Lille, 59000 Lille, France
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Saraiva LHA, Viana LDS, Pereira LC, Costa RJRM, Holsbach DR. Diferenças de sexo e idade no limiar sensitivo para estimulação elétrica transcutânea. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35148.0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Resumo Introdução A dor é um dos principais sintomas preva-lentes na maioria das patologias. A estimulação elétrica ervosa transcutânea (TENS) se apresenta não apenas como medida terapêutica, como também um meio de quantificar a percepção neurossensitiva e dolorosa em pacientes com dores crônicas. Objetivo Avaliar a relação entre sexo e idade com os limiares neurossensitivos (limiar sensitivo e limiar de tolerância) na aplicação da corrente terapêutica TENS, em pacientes com dores crônicas. Métodos Foram selecionados 45 pacientes com dores crônicas (30 mulheres), com idade entre 24 e 87 anos. Cada paciente respondeu ao Questionário Individual, ao Questionário McGill de Dor (MPQ) e ao Inventário de Depressão de Beck (BDI). Posteriormente, aplicou-se a corrente elétrica TENS, pela qual foram analisados o limiar sensitivo e doloroso, bem como a percepção de acionamento das vias neurossensitivas para cada indivíduo. Os dados foram analisados pelo pacote SPSS 24.0 for Windows. Resultados Não houve correlação significativa (p > 0,05) entre possível diagnós-tico depressivo e a percepção da corrente pelos limiares de sensibilidade e dor. Em relação ao sexo, houve diferença significativa nos limiares sensitivos (p = 0,003) entre homens e mulheres. Já para a queixa de dor e limiar de dor, não foram observadas diferenças estatísticas entre os sexos (p > 0,05). Para as análises correlacionais, identificou-se correlação significativa (p = 0,05) entre as variáveis de índice de massa corporal e limiar de tolerância à dor (r = 0,68) para o sexo feminino e idade e limiar sensitivo (r = 0,65) paro o sexo masculino. Conclusão As diferenças identificadas entre os limiares de sensibilidade entre os sexos, onde as mulheres identificaram o estímulo elétrico significativamente primeiro que os homens, podem auxiliar nas doses de intensidade ou tipo de corrente terapêutica dos pacientes.
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Affiliation(s)
| | | | - Leonardo Costa Pereira
- Centro Universitário Euro Americano, Brazil; Universidade de Brasília; Universidade do Envelhecer, Brazil
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Saraiva LHA, Viana LDS, Pereira LC, Costa RJRM, Holsbach DR. Sex and age differences in sensory threshold for transcutaneous electrical stimulation. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract Introduction Pain is one of the main symptoms prevalent in most pathologies. Transcutaneous Electrical Nerve Stimulation (TENS) represents not only a therapeutic measure, but also a mean to quantify the neurosensory and pain perception in patients with chronic pain. Objective To evaluate the relationship between sex and age with neurosensory thresholds (sensory threshold and tolerance threshold) in the application of therapeutic current in patients with chronic pain. Methods Forty-five patients with chronic pain (30 women and 15 men) aged between 24 and 87 years were selected. Each patient answered the Individual Questionnaire, McGill Pain Questionnaire (MPQ) and Beck Depression Inventory (BDI). Subsequently, the electric current was applied, through which the sensory and pain thresholds were analyzed, as well as the perception of activation of the neurosensory pathways for each individual. Data were analyzed using the SPSS 24.0 for Windows. Results There was no significant correlation (p > 0.05) between a possible depressive diagnosis and the perception of current by the sensory and pain thresholds. Regarding sex, there was a significant difference in sensory thresholds (p = 0.003) between men and women, while no statistical differences were observed between sexes for pain complaint and pain threshold (p > 0.05). For the correlational analysis, a significant correlation (p = 0.05) was identified between the variables BMI and pain tolerance threshold (r = 0.68) for females and age and sensory threshold (r = 0.65) for males. Conclusion The sex and age variables are important in the measurement of TENS parameters because they lead to significant differences in sensory and pain thresholds.
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Affiliation(s)
| | | | - Leonardo Costa Pereira
- Centro Universitário Euro Americano, Brazil; Universidade de Brasília; Universidade do Envelhecer, Brazil
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85
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Hurley-Wallace A, Kirby S, Bishop F. Trusting in the online ‘community’: An interview study exploring internet use in young people with chronic pain. Br J Pain 2021; 16:341-353. [PMID: 35646337 PMCID: PMC9136991 DOI: 10.1177/20494637211061970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Chronic pain in young people is prevalent in the UK. Young people are digital natives, yet there has not been any online intervention developed in a UK context to help them manage chronic pain. Key to understanding the context in which young people engage with online interventions is better understanding their internet use for chronic pain management. The overarching aim of this study was to explore young peoples’ experiences of searching for information about chronic pain using the internet. This included experiences of using search engines (e.g. Google), health information websites (e.g. the National Health Service [NHS] website) and social media (e.g. Facebook and Instagram). Methods Semi-structured interviews were conducted with young people aged 16–24-years (n = 24), online, via Microsoft (MS) Teams. The study was advertised online and via patient partner charities. Interview data was analysed using reflexive thematic analysis. Results Participants presented with a variety of chronic pain conditions, including joint hypermobility syndrome (n = 6), chronic headache and/or migraine (n = 4) and fibromyalgia (n = 3). Four themes were generated: ‘Trustworthy information, or experiences?’, ‘Diagnostic labels in a digital world’, ‘The online chronic pain community’ and ‘A mind and body approach to self-management’. Young people trust advice from others in their online community and having a diagnostic label help them find relevant pain management strategies and support networks online. Conclusions This study is the first qualitative exploration of internet use in UK-based young people with chronic pain. Findings highlight the importance of considering internet use when developing new online interventions for young people with pain and that internet use, particularly social media use, is an important psychosocial consideration in pain management. Young people should be encouraged to verify practical pain management techniques found online with their doctor and be empowered in the safe use of appropriate psychology-based self-management resources.
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Affiliation(s)
- Anna Hurley-Wallace
- Anna Hurley-Wallace, Psychology Department, University of Southampton, Shackleton (Building 44), Southampton, Hampshire SO17 1BJ, UK.
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86
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Cardinali A, Celini D, Chaplik M, Grasso E, Nemec EC. Efficacy of Transcutaneous Electrical Nerve Stimulation for Postoperative Pain, Pulmonary Function, and Opioid Consumption Following Cardiothoracic Procedures: A Systematic Review. Neuromodulation 2021; 24:1439-1450. [PMID: 33215794 DOI: 10.1111/ner.13302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Transcutaneous electrical nerve stimulation (TENS) is a minimally invasive method for treating pain. In the most recent review published in 2012, TENS was associated with increased pain relief following cardiothoracic surgery when compared to standard multimodal analgesia. The purpose of this systematic review and meta-analysis is to determine if adding TENS to current pain management practices decreases pain and analgesic use and improves pulmonary function for postcardiothoracic surgery patients. MATERIALS AND METHODS CINAHL, MEDLINE, Cochrane Database of Systematic Reviews, PubMed, and ClinicalTrials.gov were searched using specific keywords. Covidence was used to screen, select studies, and extract data by two independent reviewers. The Cochrane Risk of Bias tool assessed risk of bias. Visual analog scale (VAS) and pulmonary function data were exported for meta-analysis using a random effects model. RESULTS The search yielded 38 articles. Eight randomized controlled trials met inclusion criteria for the literature review. Five studies were included in the meta-analysis of pain at 24, 48, and 72 hours postoperatively. Data were analyzed using the standard mean difference (SMD). TENS had a significant impact on VAS at rest (-0.76 SMD [95% confidence interval, CI = -1.06 to -0.49], p < 0.00001) and with coughing (-1.11 SMD [95% CI = -1.64 to -0.56], p < 0.0001). FEV1 improved after 72 hours (1.00 SMD [95% CI = 0.66-1.35], p < 0.00001), as did forced vital capacity (1.16 SMD [95% CI = 0.23-2.10], p = 0.01). CONCLUSION The addition of TENS therapy to multimodal analgesia significantly decreases pain following cardiothoracic surgery, increases the recovery of pulmonary function, and decreases the use of analgesics.
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87
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Olivencia O, Kaplan K, Dreger M, Veloz M, Kais A, Marlowe K. Postrehabilitation Considerations for Individuals With Temporomandibular Disorders. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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88
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Alenazy M, Daneshgar Asl S, Petrigna L, Feka K, Alvarez E, Almuklass AM, Enoka RM. Treatment with electrical stimulation of sensory nerves improves motor function and disability status in persons with multiple sclerosis: A pilot study. J Electromyogr Kinesiol 2021; 61:102607. [PMID: 34710779 DOI: 10.1016/j.jelekin.2021.102607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 01/26/2023] Open
Abstract
Declines in motor function are closely associated with decreases in sensory function in multiple sclerosis (MS). The purpose of our study was to assess the changes in motor function and disability status elicited by transcutaneous electrical nerve stimulation (TENS) to limb muscles of individuals with MS. Fifteen persons with MS and 11 age-matched healthy controls were evaluated before and after receiving 9 treatment sessions during which TENS was applied over the tibialis anterior and rectus femoris muscles of each leg, and over the median nerve and the thenar eminence of each hand. Each evaluation session involved completing two questionnaires (fatigue and walking limitations) and assessing walking performance (2-min test and 25-ft test), dynamic balance (chair-rise test), manual dexterity (grooved pegboard test), and muscle function of hands and legs (strength and force steadiness tests). The MS group exhibited improvements in the 25-ft test (P = 0.001), 2-min test (P = 0.002), chair-rise test (P = 0.008), grooved pegboard test (P = 0.008), and reductions in the self-reported levels of fatigue and walking limitation scores (P = 0.02, d = 0.52; P = 0.008, r = 0.50 respectively). In contrast, there were no statistically significant changes in the Control group. There were no significant changes in either muscle strength or force steadiness for either group. TENS elicited significant improvements in motor function and self-reported disability status in persons with MS. Some improvements reached clinically meaningful levels.
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Affiliation(s)
- Mohammed Alenazy
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA.
| | | | - Luca Petrigna
- PhD Program in Health Promotion and Cognitive Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, Italy
| | - Kaltrina Feka
- PhD Program in Health Promotion and Cognitive Sciences, Sport and Exercise Sciences Research Unit, University of Palermo, Italy
| | - Enrique Alvarez
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Awad M Almuklass
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Roger M Enoka
- Department of Integrative Physiology, University of Colorado, Boulder, CO, USA
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Pandita V, Ajila V, Babu GS, Hegde S, Asan MF. Transcutaneous Electrical Nerve Stimulation: A Review of Dental Applications. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1736275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractTranscutaneous electrical nerve stimulation or TENS is a nonpharmacologic method that is used to alleviate pain from various acute and chronic conditions. TENS works through activation of descending inhibitory neurons of the central nervous system. In dentistry, TENS has applications for pain reduction in temporomandibular disorders and postherpetic neuralgia. It has also been studied for its role in increasing salivary secretion in subjects with xerostomia and as a local anesthetic agent in pediatric dentistry. Its wide applications in the orofacial region make it an important treatment modality. The purpose of the present review was to describe the general principles and its applications in dentistry along with its indications, advantages, and disadvantages. A web-based search was conducted using the keywords “transcutaneous electrical nerve stimulation,” “temporomandibular joint,” “TENS,” “TMJ,” “orofacial pain,” and “Management.” The manuscripts thus obtained were evaluated and used for compiling the present narrative review. The present review focuses on the mechanism of action, applications, and effectiveness of TENS in the management of diseases of the maxillofacial region.
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Affiliation(s)
- Vaibhav Pandita
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Vidya Ajila
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - G. Subhas Babu
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Shruthi Hegde
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Mohamed Faizal Asan
- Department of Oral Medicine and Radiology, AB Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India
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90
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Chiu PE, Fu Z, Jian GW, Huang CH, Li TM, Chou LW. Evaluating Effectiveness of Fu's Subcutaneous Needling for the Pain Nature and Quality of Life in Patients with Knee Osteoarthritis: A Study Protocol of Randomized Clinical Trial. J Pain Res 2021; 14:3163-3172. [PMID: 34675644 PMCID: PMC8517913 DOI: 10.2147/jpr.s333299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 12/28/2022] Open
Abstract
Background Knee osteoarthritis (OA) is a common clinical disease. Knee pain is the major symptom of knee OA and the primary reason why patients seek treatment. Fu’s subcutaneous needling (FSN) has been used to treat knee OA for more than 20 years. However, the establishment of treatment methods and rigorous evaluation of FSN’s efficacy are still lacking. A randomized single-blind clinical trial will be conducted to evaluate whether FSN treatment can immediately alleviate pain due to knee OA surrounding the patella and the curative effective of 1-week and 2-week treatments. In addition, the feasibility and initial effect of FSN treatment for patients with knee OA will be discussed. Materials and Methods Patients with confirmed knee OA, as diagnosed by doctors using X-ray films or from clinical symptoms, who are over 50 years old will be participants recruited. They will be randomly assigned either FSN treatment or transcutaneous electrical nerve stimulation treatment. In addition, their pressure pain threshold, muscle tone of lower leg muscle, and physical ability will be measured. Participants will be asked to complete the questionnaires of Western Ontario and McMaster Universities Osteoarthritis Index and Lequesne’ index as the measurements for quality of life. Results The findings of this study will reveal whether FSN or transcutaneous electrical nerve stimulation is clinically efficacious for treating pain due to knee OA, with respect to muscle stiffness, gait, dynamic balance, the pressure pain threshold, and quality of life before and after treatment. Study Registration This study is approved by the Research Ethics Committee of China Medical University & Hospital, Taichung, Taiwan (CMUH107-REC3-027) and registered at the ClinicalTrials.gov Protocol Registration and Results System (registration number NCT04356651).
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Affiliation(s)
- Po-En Chiu
- Department of Chinese Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Zhonghua Fu
- Institute of Fu's Subcutaneous Needling, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Guan-Wei Jian
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, Sinying Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Ching-Hsuan Huang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Chinese Traumatology Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Te-Mao Li
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.,Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan.,Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan
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91
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Yu MD, Park JK, Kossler AL. Stimulating Tear Production: Spotlight on Neurostimulation. Clin Ophthalmol 2021; 15:4219-4226. [PMID: 34707341 PMCID: PMC8542570 DOI: 10.2147/opth.s284622] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
Dry eye disease (DED) affects up to one-third of the global population. Traditional therapies, including topical lubricants, have been employed with variable success in the treatment of DED. Recently, neurostimulation of the lacrimal functional unit (LFU) has emerged as a promising alternative therapy for DED. In this review, we describe the neuroanatomical and pathophysiological considerations of DED and the LFU that make neurostimulation a viable therapeutic alternative. We further detail the various neurostimulatory approaches taken thus far-from implanted stimulators to external devices to chemical neurostimulation. Existing studies reveal the strengths of the neurostimulatory approach in increasing tear volume and improving dry eye symptoms, but further studies are needed to elucidate its true potential in treatment of DED.
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Affiliation(s)
- Michael D Yu
- Oculoplastic Surgery and Orbital Oncology Service, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Ji Kwan Park
- Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, USA
| | - Andrea L Kossler
- Oculoplastic Surgery and Orbital Oncology Service, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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92
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Cashin AG, Rizzo RRN, Wand BM, O'Connell NE, Lee H, Bagg MK, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane Reviews. Hippokratia 2021. [DOI: 10.1002/14651858.cd014691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aidan G Cashin
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Rodrigo RN Rizzo
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- School of Health Sciences, Faculty of Medicine and Health; The University of New South Wales; Sydney Australia
| | - Benedict M Wand
- School of Physiotherapy; The University of Notre Dame Australia; Fremantle Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse; Brunel University London; Uxbridge UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); University of Oxford; Oxford UK
- School of Medicine and Public Health; The University of Newcastle; Newcastle Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Edel O'Hagan
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Christopher G Maher
- Sydney School of Public Health; The University of Sydney; Sydney Australia
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
| | | | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences; VU University Amsterdam; Amsterdam Netherlands
| | - James H McAuley
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- School of Health Sciences, Faculty of Medicine and Health; The University of New South Wales; Sydney Australia
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93
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Gonçalves PEO, Milanez M, Flumignan RLG, Machado J, Navarro TP, Cisneros LDL. Transcutaneous Electric Nerve Stimulation on ischemic rest pain in inpatients: randomised trial. ACTA ACUST UNITED AC 2021; 67:213-217. [PMID: 34406244 DOI: 10.1590/1806-9282.67.02.20200535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/14/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the efficacy of a short-term application of Transcutaneous Electric Nerve Stimulation to relieve rest pain in patients with chronic limb-threatening ischemia. METHODS In patients ³18 years old, with chronic limb-threatening ischemia and rest pain ³3 in the Visual Analogue Scale, without diabetic neuropathy were randomly assigned to 1) Transcutaneous Electric Nerve Stimulation (100 Hz, 200 μs) or 2) sham intervention, both during one or two 20 min treatment sessions. The primary outcome was pain intensity, assessed by the visual analogue scale (0-10 cm) and described by the McGill Pain Questionnaire. We used a t-test for difference of means. RESULTS A total of 169 patients were assessed, 23 met the study criteria and were randomized. Thirty-four applications were performed in two days: in the 17 Transcutaneous Nerve Stimulation and 17 sham. The within-group analysis indicated a pain decrease in both groups (Transcutaneous Electric Nerve Stimulation, from 7-3.9 cm, p<0.0001, and sham from 5.8-3.2 cm, p<0.0001). No statistically significant difference was verified between-groups (p=0.5). CONCLUSIONS Both groups showed a decrease in rest pain of 54 and 55%, respectively. However, there was no difference between short-term high-frequency Transcutaneous Electric Nerve Stimulation and sham intervention to relieve ischemic rest pain in chronic limb-threatening ischemia patients.
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Affiliation(s)
| | - Matheus Milanez
- Universidade Federal de Minas Gerais, Department of Physical Therapy - Belo Horizonte (MG), Brazil
| | - Ronald Luiz Gomes Flumignan
- Universidade Federal de São Paulo, Division of Vascular and Endovascular Surgery, Department of Surgery - São Paulo (SP), Brazil
| | - Jorge Machado
- Universidade Federal de Minas Gerais, Department of Preventive and Social Medicine, School of Medicine - Belo Horizonte (MG), Brazil
| | - Tulio Pinho Navarro
- Universidade Federal de Minas Gerais, School of Medicine, Department of Surgery - Belo Horizonte (MG), Brazil
| | - Ligia de Loiola Cisneros
- Universidade Federal de Minas Gerais, Department of Physical Therapy - Belo Horizonte (MG), Brazil
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94
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Patel K, Batchu S, Wang R, Bunachita S, Joshi A, Soni R, Pandya A, Patel U. The Use of Electrical Nerve Stimulation to Treat Migraines: A Systematic Review. Cureus 2021; 13:e17554. [PMID: 34646611 PMCID: PMC8481154 DOI: 10.7759/cureus.17554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/29/2021] [Indexed: 11/05/2022] Open
Abstract
Migraines have been defined as an intense unilateral throbbing or pulsating sensation lasting anywhere between a few hours to multiple days. They are the sixth most prevalent disease in the United States, with approximately 18% of women and 6% of men experiencing some form of a migraine throughout their lifetime. In addition, they pose a significant economic burden, accounting for anywhere between $13 and $17 billion in medical costs annually in the United States. While there are a wide variety of treatments for migraines on the market, such as nonsteroidal anti-inflammatory drugs (NSAIDS), beta-blockers, and anti-epileptics, there is still no standard treatment. Moreover, each of these medications has a wide range of side effects, ranging from stomach ulcers to light-headedness. Within the last few decades, the presence of electrical nerve stimulation has emerged as a possible treatment option. These methods are almost free of harmful side effects and may be able to reduce the economic burden on those who suffer from migraines. However, studies have shown mixed results in regard to their efficacy. In this paper, we performed a systematic review to detail the current state of the literature regarding electrical nerve stimulation as a treatment modality for migraines.
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Affiliation(s)
- Karan Patel
- Medicine, Cooper Medical School of Rowan University, Camden, USA
| | - Sai Batchu
- Medicine, Cooper Medical School of Rowan University, Camden, USA
| | - Rebecca Wang
- Medicine, Hackensack Meridian School of Medicine, Nutley, USA
| | - Sean Bunachita
- Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Aditya Joshi
- Medicine, Cooper Medical School of Rowan University, Camden, USA
- Orthopaedics, Cooper Medical School of Rowan University, Camden, USA
| | - Ria Soni
- Medicine, Rutgers University, New Brunswick, USA
| | - Aadi Pandya
- Medicine, Herricks High School, New Hyde Park, USA
| | - Urvish Patel
- Epidemiology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
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Jamison RN, Edwards RR, Curran S, Wan L, Ross EL, Gilligan CJ, Gozani SN. Effects of Wearable Transcutaneous Electrical Nerve Stimulation on Fibromyalgia: A Randomized Controlled Trial. J Pain Res 2021; 14:2265-2282. [PMID: 34335055 PMCID: PMC8318714 DOI: 10.2147/jpr.s316371] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Fibromyalgia is a chronic condition characterized by widespread pain and interference with daily activities. The aim of this study is to assess the benefit of transcutaneous electrical nerve stimulation (TENS) for persons diagnosed with fibromyalgia. Patients and Methods Adults meeting diagnostic criteria for fibromyalgia were randomized in a double-blind trial to receive either an active (n=62) or sham (n=57) wearable TENS device for 3-months. Subjects were classified as having lower or higher pain sensitivity by Quantitative Sensory Testing (QST). Patient Global Impression of Change (PGIC, primary outcome) and secondary efficacy measures including Fibromyalgia Impact Questionnaire (FIQR), Brief Pain Inventory (BPI) and painDETECT questionnaire (PDQ) were assessed at baseline, 6-weeks and 3-months. Treatment effects were determined by a mixed model for repeated measures (MMRM) analysis of the intention-to-treat (ITT) population (N=119). A pre-specified subgroup analysis of pain sensitivity was conducted using an interaction term in the model. Results No differences were found between active and sham treatment on PGIC scores at 3-months (0.34, 95% CI [−0.37, 1.04], p=0.351) in the ITT population. However, in subjects with higher pain sensitivity (n=60), PGIC was significantly greater for active treatment compared to sham (1.19, 95% CI [0.24, 2.13], p=0.014). FIQR total score (−7.47, 95% CI [−12.46, −2.48], p=0.003), FIQR pain item (−0.62, 95% CI [−1.17, −0.06], p=0.029), BPI Interference (−0.70, 95% CI [−1.30, −0.11], p=0.021) and PDQ (−1.69, 95% CI [−3.20, −0.18], p=0.028) exhibited significant improvements for active treatment compared to sham in the ITT population. Analgesics use was stable and comparable in both groups. Conclusion This study demonstrated modest treatment effects of reduced disease impact, pain and functional impairment from wearable TENS in individuals with fibromyalgia. Subjects with higher pain sensitivity exhibited larger treatment effects than those with lower pain sensitivity. Wearable TENS may be a safe treatment option for people with fibromyalgia. Clinicaltrials.gov Registration NCT03714425.
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Affiliation(s)
- Robert N Jamison
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Samantha Curran
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Limeng Wan
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Edgar L Ross
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
| | - Christopher J Gilligan
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Chestnut Hill, MA, USA
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96
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Rehabilitation of An Analgesic Bracelet Based on Wrist-Ankle Acupuncture in Patients with Rotator Cuff Injury: A Randomized Trial. Pain Res Manag 2021; 2021:9946548. [PMID: 34336070 PMCID: PMC8292086 DOI: 10.1155/2021/9946548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 12/21/2022]
Abstract
Objective To evaluate the effect of transcutaneous electrical nerve stimulation (C-TENS) in the rehabilitation of rotator cuff injury. Methods A total of 60 patients diagnosed with mild to moderate rotator cuff injury were randomly divided into the control group and test group. Both groups received conventional rehabilitation treatment including physical therapy, joint mobilization, interventional therapy, and family recovery training. The test group additionally received TENS treatment on the upper area 4 or 5 of the wrist, based on the wrist-ankle acupuncture (WAA) theory. The results of the visual analogue scale (VAS), shoulder range of motion (ROM), and Constant-Murley score (CMs) were collected before and after the 1st treatment and after the 5th treatment. The differences of those indicators between the two groups were analyzed statistically. Results The VAS scores of measurement points after treatment were all improved compared with those at baseline. There was a significant difference between the two groups after the 1st and the 5th treatment (p < 0.05), and the improvements in the test group were better than those in the control group. The ROM of flexion, extension, abduction, adduction, internal rotation, and external rotation after the 1st treatment and 5th treatment in both groups were all improved compared with those at baseline. There was no significant difference between two groups. The CMs of the two groups after the 5th treatment were all improved compared with those at baseline. There was no significant difference between two groups. No adverse events occurred during the treatment. Conclusion Electrical stimulation on the wrist combined with conventional rehabilitation is more effective in relieving pain than the conventional rehabilitation alone. Electrical stimulation on the wrist combined with conventional rehabilitation has no obvious effect in improving shoulder joint mobility and shoulder function.
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97
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Bhoi D, Jain D, Garg R, Iyengar KP, Hoda W, Vaishya R, Jain VK. Complementary and Alternative Modalities (CAM) for pain management in musculoskeletal diseases (MSDs). J Clin Orthop Trauma 2021; 18:171-180. [PMID: 34017678 PMCID: PMC8113975 DOI: 10.1016/j.jcot.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/16/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
Musculoskeletal diseases are a group of clinical conditions affecting the body's movement and remain a common source of pain affecting the quality of life. The aetio-pathological reasons for pain associated with musculoskeletal diseases can be varied and complex. Conventional medicine can treat or modify pain due to musculoskeletal diseases; however, these may be associated with some side effects and at times may not be able to relieve pain completely. These treatment modalities also have ceiling effects like doses of analgesics, the number of nerve blocks, etc. Complementary and Alternative Medicine (CAM) provides a supplementary, unconventional modality to alleviate discomfort and disability associated with these mostly chronic conditions to manage activities of daily living. These modalities have been variedly combined with conventional management for symptom control and thus improve day-to-day activities. We assess the role of commonly used CAM modalities in the management of pain arising from Musculoskeletal diseases.
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Affiliation(s)
- Debesh Bhoi
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, 110029, India
| | - Dhruv Jain
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Garg
- Department of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Karthikeyan P. Iyengar
- Trauma and Orthopaedic Surgeon, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, UK
| | - Wasimul Hoda
- Department of Superspeciality Anesthesia, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Vijay Kumar Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India
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98
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Abstract
PURPOSE OF REVIEW Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED. RECENT FINDINGS Neuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types. SUMMARY Several alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.
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Affiliation(s)
- Rhiya Mittal
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Sneh Patel
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Research Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
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99
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Zhang Y, Al Mamun A, Yuan Y, Lu Q, Xiong J, Yang S, Wu C, Wu Y, Wang J. Acute spinal cord injury: Pathophysiology and pharmacological intervention (Review). Mol Med Rep 2021; 23:417. [PMID: 33846780 PMCID: PMC8025476 DOI: 10.3892/mmr.2021.12056] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Spinal cord injury (SCI) is one of the most debilitating of all the traumatic conditions that afflict individuals. For a number of years, extensive studies have been conducted to clarify the molecular mechanisms of SCI. Experimental and clinical studies have indicated that two phases, primary damage and secondary damage, are involved in SCI. The initial mechanical damage is caused by local impairment of the spinal cord. In addition, the fundamental mechanisms are associated with hyperflexion, hyperextension, axial loading and rotation. By contrast, secondary injury mechanisms are led by systemic and cellular factors, which may also be initiated by the primary injury. Although significant advances in supportive care have improved clinical outcomes in recent years, a number of studies continue to explore specific pharmacological therapies to minimize SCI. The present review summarized some important pathophysiologic mechanisms that are involved in SCI and focused on several pharmacological and non‑pharmacological therapies, which have either been previously investigated or have a potential in the management of this debilitating injury in the near future.
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Affiliation(s)
- Yi Zhang
- School of Chemical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, P.R. China
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Abdullah Al Mamun
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Yuan Yuan
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Qi Lu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Jun Xiong
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Shulin Yang
- School of Chemical Engineering, Nanjing University of Science and Technology, Nanjing, Jiangsu 210094, P.R. China
| | - Chengbiao Wu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Yanqing Wu
- Institute of Life Sciences, Wenzhou University, Wenzhou, Zhejiang 325035, P.R. China
| | - Jian Wang
- Department of Hand Surgery and Peripheral Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
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100
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Jamison RN, Curran S, Wan L, Ross EL, Gilligan CJ, Edwards RR. Higher Pain Sensitivity Predicts Efficacy of a Wearable Transcutaneous Electrical Nerve Stimulation Device for Persons With Fibromyalgia: A Randomized Double-Blind Sham-Controlled Trial. Neuromodulation 2021; 25:1410-1420. [PMID: 34056781 DOI: 10.1111/ner.13463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study investigated the efficacy of a transcutaneous electrical nerve stimulation (TENS) device (Quell®) for persons with symptoms due to fibromyalgia (FM). MATERIALS AND METHODS One hundred nineteen (N = 119) subjects were randomly assigned to use an active (N = 62) or sham (N = 57) TENS for three months. All subjects completed baseline questionnaires and were administered quantitative sensory testing (QST). Subjects completed the Patients' Global Impression of Change (PGIC, primary outcome measure) and other mailed questionnaires (secondary outcome measures) at six weeks and three months. RESULTS The subjects averaged 50.4 ± 13.5 years of age, 93.3% were female, and 79.8% were Caucasian. Most showed benefit from using the TENS, but no differences between groups were found on the primary outcome measure after three months (active 3.87 ± 1.85, sham 3.73 ± 1.80, 95% confidence interval [CI] [-0.60, 0.88], p = 0.707). Those with more hypersensitivity showed most improvement on the PGIC at six weeks (0.22, 95% CI [0.01, 0.43], p = 0.042) and three months (0.20, 95% CI [0.00, 0.41], p = 0.049) and among those with higher sensitivity based on QST, the active TENS group showed the most benefit with TENS compared with the sham treatment (1.20, 95% CI [0.22, 2.18], p = 0.017). No TENS-related serious adverse events were reported. Subjects in the sham group correctly identified their treatment 87.5% of the time, while, surprisingly, subjects in the active group correctly identified their treatment only 17.4% of the time. CONCLUSION This study found no differences between those who were exposed to maximal-frequency active stimulation or minimal-frequency sham stimulation from a wearable TENS in reducing FM-related symptoms. However, those with greater hypersensitivity showed most benefit from TENS. Additional studies to help determine the role individual differences play in the use of TENS in managing FM-related symptoms are needed.
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Affiliation(s)
- Robert N Jamison
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Samantha Curran
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Limeng Wan
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Edgar L Ross
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Christopher J Gilligan
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| | - Robert R Edwards
- Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
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