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Song X, Zhu Q, Su L, Shi L, Chi H, Yan Y, Luo M, Xu X, Liu B, Liu Z, Yang J. New perspectives on migraine treatment: a review of the mechanisms and effects of complementary and alternative therapies. Front Neurol 2024; 15:1372509. [PMID: 38784897 PMCID: PMC11111892 DOI: 10.3389/fneur.2024.1372509] [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: 01/18/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024] Open
Abstract
Migraine is a prevalent and disabling neurovascular disorder, with women being more susceptible, characterized by unilateral throbbing headache, often accompanied by nausea and vomiting, and often associated with various comorbidities such as brain and cardiovascular diseases, which can have a serious impact on quality of life. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are the main first-line medications for the treatment of pain, long-term use often leads to side effects and drug addiction, which emphasizes the need to investigate alternative pain management strategies with fewer adverse effects. Complementary and alternative medicine is a viable pain intervention often used in conjunction with traditional medications, including acupuncture, herbs, moxibustion, transcutaneous electrical stimulation, bio-supplements, and acupressure, which offer non-pharmacological alternatives that are now viable pain management options. This review focuses on the mechanistic doctrine of migraine generation and the role and potential mechanisms of Complementary and Alternative Therapies (CAT) in the treatment of migraine, summarizes the research evidences for CAT as an adjunct or alternative to conventional therapies for migraine, and focuses on the potential of novel migraine therapies (calcitonin gene-related peptide (CGRP) antagonists and pituitary adenylyl cyclase-activating peptide (PACAP) antagonists) with the aim of evaluating CAT therapies as adjunctive or alternative therapies to conventional migraine treatment, thereby providing a broader perspective on migraine management and the design of treatment programs for more effective pain management.
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Affiliation(s)
- Xiaoli Song
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qian Zhu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Lanqian Su
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Lei Shi
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hao Chi
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Yalan Yan
- Clinical Medical College, Southwest Medical University, Luzhou, China
| | - Mei Luo
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xibin Xu
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | | | - Zhengyang Liu
- Evidence Based Oriental Medicine clinic, Sioux Falls, SD, United States
| | - Jin Yang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Gautam M, Yamada A, Yamada AI, Wu Q, Kridsada K, Ling J, Yu H, Dong P, Ma M, Gu J, Luo W. Distinct local and global functions of mouse Aβ low-threshold mechanoreceptors in mechanical nociception. Nat Commun 2024; 15:2911. [PMID: 38575590 PMCID: PMC10995180 DOI: 10.1038/s41467-024-47245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
The roles of Aβ low-threshold mechanoreceptors (LTMRs) in transmitting mechanical hyperalgesia and in alleviating chronic pain have been of great interest but remain contentious. Here we utilized intersectional genetic tools, optogenetics, and high-speed imaging to specifically examine functions of SplitCre labeled mouse Aβ-LTMRs in this regard. Genetic ablation of SplitCre-Aβ-LTMRs increased mechanical nociception but not thermosensation in both acute and chronic inflammatory pain conditions, indicating a modality-specific role in gating mechanical nociception. Local optogenetic activation of SplitCre-Aβ-LTMRs triggered nociception after tissue inflammation, whereas their broad activation at the dorsal column still alleviated mechanical hypersensitivity of chronic inflammation. Taking all data into consideration, we propose a model, in which Aβ-LTMRs play distinctive local and global roles in transmitting or alleviating mechanical hyperalgesia of chronic pain, respectively. Our model suggests a strategy of global activation plus local inhibition of Aβ-LTMRs for treating mechanical hyperalgesia.
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Affiliation(s)
- Mayank Gautam
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Akihiro Yamada
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Ayaka I Yamada
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Qinxue Wu
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kim Kridsada
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jennifer Ling
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Huasheng Yu
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Peter Dong
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Minghong Ma
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jianguo Gu
- Department of Anesthesiology and Perioperative Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Wenqin Luo
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Liu C, Pang L, Wang L, Zhang L, Ma D, Chen J, Nie G. A Pharmacotherapeutic Approaches for Managing Labour Pain Using Synthetic Drugs and Natural Therapies. Comb Chem High Throughput Screen 2024; 27:1276-1285. [PMID: 37464818 DOI: 10.2174/1386207326666230718144457] [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] [Received: 03/10/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2023]
Abstract
The birth of a child is a critical and potentially traumatic experience for women, entailing multiple physiological and psychosocial changes. The psychological effects of childbirth pain can have both immediate and long-term effects on the mother's health and her bond with her child. Many studies investigated the different ranges of synthetic drugs available for pain control in labour, inclusive of neuraxial analgesics, inhaled analgesics, and various opioids. The inadequate efficacy and unfavourable side effects of these synthetic drugs prevent appropriate pharmacotherapy, resulting in a quest for natural therapies for reducing labour pain. Herbal therapies (aromatherapy) using several essential oils obtained from various natural plants are another alternative that calms and manages the mind and body through aromatic compounds that have neurological and physiological effects. The review discussed the safety profile of various synthetic drugs with their dosage information and also deliberated on the mechanism and safety profile of various natural plants that are used in aromatherapy. The review also briefly highlighted the other non-pharmacological miscellaneous techniques such as TENS, hypnosis, immersion in water, acupuncture, massage, and different other tactics that aim to assist women in coping with pain in labour.
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Affiliation(s)
- Chunxiao Liu
- Department of Obstetrics, Dezhou Maternity and Child Health Care Hospital, Dezhou, 253000, China
| | - Liyan Pang
- Department of Obstetrics, Dezhou Maternity and Child Health Care Hospital, Dezhou, 253000, China
| | - Lijuan Wang
- Department of Obstetrics, Laoling People's Hospital, Dezhou City, 253600, China
| | - Lili Zhang
- Department of Obstetrics, Laoling People's Hospital, Dezhou City, 253600, China
| | - Dandan Ma
- Department of Obstetrics, Dezhou Maternity and Child Health Care Hospital, Dezhou, 253000, China
| | - Jing Chen
- Department of Obstetrics, Dezhou Maternity and Child Health Care Hospital, Dezhou, 253000, China
| | - Guimei Nie
- Department of Obstetrics and Gynecology, Jiuquan City People's Hospital, Jiuquan, Gansu, 735000, China
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Allen CB, Williamson TK, Norwood SM, Gupta A. Do Electrical Stimulation Devices Reduce Pain and Improve Function?-A Comparative Review. Pain Ther 2023; 12:1339-1354. [PMID: 37751060 PMCID: PMC10616008 DOI: 10.1007/s40122-023-00554-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Multiple forms of electrical stimulation (ES) potentially offer widely varying clinical benefits. Diminished function commonly associated with acute and chronic pain lessens productivity and increases medical costs. This review aims to compare the relative effects of various forms of ES on functional and pain outcomes. METHODS A comprehensive literature search focused on studies of commonly marketed forms of ES used for treatment of pain and improvement of function. Peer-reviewed manuscripts were categorized as "Important" (systematic review or meta-analysis, randomized controlled trial, observational cohort study) and "Minor" (retrospective case series, case report, opinion review) for each identified form of ES. RESULTS AND DISCUSSION Varying forms of ES have markedly different technical parameters, applications, and indications, based on clinically meaningful impact on pain perception, function improvement, and medication reduction. Despite being around for decades, there is limited quality evidence for most forms of ES, although there are several notable exceptions for treatment of specific indications. Neuromuscular electrical stimulation (NMES) has well-demonstrated beneficial effects for rehabilitation of selective spinal cord injured (SCI), post-stroke, and debilitated inpatients. Functional electrical stimulation (FES) has similarly shown effectiveness in rehabilitation of some stroke, SCI, and foot drop outpatients. H-Wave® device stimulation (HWDS) has moderate supportive evidence for treatment of acute and refractory chronic pain, consistently demonstrating improvements in function and pain measures across diverse populations. Interestingly, transcutaneous electrical nerve stimulation (TENS), the most widely used form of ES, demonstrated insignificant or very low levels of pain and functional improvement. CONCLUSION Ten of 13 reviewed forms of ES have only limited quality evidence for clinically significant reduction of pain or improvement of function across different patient populations. NMES and FES have reasonably demonstrated effectiveness, albeit for specific clinical rehabilitation indications. HWDS was associated with the most clinically significant outcomes, in terms of functional improvement combined with reduction of pain and medication use. More rigorous long-term clinical trials are needed to further validate appropriate use and specific indications for most forms of ES. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Christian B Allen
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, 78235, USA
| | - Tyler K Williamson
- Department of Orthopaedic Surgery, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | | | - Ashim Gupta
- Future Biologics, Lawrenceville, GA, 30043, USA.
- Regenerative Orthopaedics, Noida, Uttar Pradesh, 201301, India.
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Nori W, Kassim MAK, Helmi ZR, Pantazi AC, Brezeanu D, Brezeanu AM, Penciu RC, Serbanescu L. Non-Pharmacological Pain Management in Labor: A Systematic Review. J Clin Med 2023; 12:7203. [PMID: 38068274 PMCID: PMC10707619 DOI: 10.3390/jcm12237203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 04/22/2024] Open
Abstract
Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women's individual requirements, to strengthen obstetricians' knowledge in guiding decision-making for women in childbirth.
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Affiliation(s)
- Wassan Nori
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Mustafa Ali Kassim Kassim
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Zeena Raad Helmi
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Alexandru Cosmin Pantazi
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Dragos Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Ana Maria Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Roxana Cleopatra Penciu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Lucian Serbanescu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
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Watanabe J, Izumi N, Kobayashi F, Miki A, Sata N. Efficacy and Safety of Transcutaneous Electrical Nerve Stimulation in Patients Undergoing Inguinal Hernia Repair: A Systematic Review and Meta-analysis. JMA J 2023; 6:371-380. [PMID: 37941690 PMCID: PMC10628323 DOI: 10.31662/jmaj.2023-0056] [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: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 11/10/2023] Open
Abstract
Background Postoperative pain is a major cause of delayed recovery following inguinal hernia repair. Transcutaneous electrical nerve stimulation (TENS) is a simple, low-cost method of noninvasive analgesia. This study aimed to assess the efficacy and safety of TENS for pain management following inguinal hernia repair. Methods We searched nine electronic databases and trial registries to identify randomized controlled trials (RCTs). The primary outcomes were postoperative pain and the use of rescue analgesics. The Risk of Bias 2 tool was used to evaluate the risk of bias in the included trials. The certainty of the evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Subgroup analyses were conducted based on the anesthesia type or TENS dose and frequency. This study is registered with PROSPERO (CRD42022353932). Results Eleven RCTs, with a total of 559 patients, were included. The overall risk of bias was concerning due to the lack of information about concealment or published protocols. TENS may reduce pain on postoperative day (POD) 0 (standardized mean difference [SMD], -2.14; 95% confidence interval [CI], -3.54 to -0.73; moderate certainty of the evidence), POD 1 (SMD, -1.22; 95% CI, -1.92 to -0.52; moderate certainty of the evidence), and POD 2 (SMD, -0.97; 95% CI, -2.04 to 0.10; low certainty of the evidence). According to the subgroup analyses, postoperative pain was reduced, particularly with local anesthesia or repetitive and frequent TENS (P < 0.05). TENS may result in little-to-no difference in rescue analgesic use (risk ratio, 0.75; 95% CI, 0.47-1.18; low certainty of the evidence). No serious adverse events occurred (moderate certainty of the evidence). Conclusions TENS may reduce pain in patients who have undergone inguinal hernia repair. Further trials are warranted to confirm our findings.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Naoto Izumi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Fuyumi Kobayashi
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Miki
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Naohiro Sata
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Japan
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Aurucci GV, Preatoni G, Damiani A, Raspopovic S. Brain-Computer Interface to Deliver Individualized Multisensory Intervention for Neuropathic Pain. Neurotherapeutics 2023; 20:1316-1329. [PMID: 37407726 PMCID: PMC10480109 DOI: 10.1007/s13311-023-01396-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
To unravel the complexity of the neuropathic pain experience, researchers have tried to identify reliable pain signatures (biomarkers) using electroencephalography (EEG) and skin conductance (SC). Nevertheless, their use as a clinical aid to design personalized therapies remains scarce and patients are prescribed with common and inefficient painkillers. To address this need, novel non-pharmacological interventions, such as transcutaneous electrical nerve stimulation (TENS) to activate peripheral pain relief via neuromodulation and virtual reality (VR) to modulate patients' attention, have emerged. However, all present treatments suffer from the inherent bias of the patient's self-reported pain intensity, depending on their predisposition and tolerance, together with unspecific, pre-defined scheduling of sessions which does not consider the timing of pain episodes onset. Here, we show a Brain-Computer Interface (BCI) detecting in real-time neurophysiological signatures of neuropathic pain from EEG combined with SC and accordingly triggering a multisensory intervention combining TENS and VR. After validating that the multisensory intervention effectively decreased experimentally induced pain, the BCI was tested with thirteen healthy subjects by electrically inducing pain and showed 82% recall in decoding pain in real time. Such constructed BCI was then validated with eight neuropathic patients reaching 75% online pain precision, and consequently releasing the intervention inducing a significant decrease (50% NPSI score) in neuropathic patients' pain perception. Our results demonstrate the feasibility of real-time pain detection from objective neurophysiological signals, and the effectiveness of a triggered combination of VR and TENS to decrease neuropathic pain. This paves the way towards personalized, data-driven pain therapies using fully portable technologies.
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Affiliation(s)
- Giuseppe Valerio Aurucci
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Greta Preatoni
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Arianna Damiani
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland
| | - Stanisa Raspopovic
- Laboratory for Neuroengineering, Department of Health Science and Technology, Institute for Robotics and Intelligent Systems, ETH Zürich, 8092, Zurich, Switzerland.
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Xiao G, Weng M, Wang P. Transcutaneous electrical nerve stimulation combined with levofloxacin and tamsulosin for patients with chronic prostatitis: clinical efficacy and changes in serum factors. Am J Transl Res 2023; 15:5267-5275. [PMID: 37692965 PMCID: PMC10492048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/25/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To analyze the effects of transcutaneous electrical nerve stimulation (TENS) combined with levofloxacin (0.1 g, twice daily) and tamsulosin (0.2 mg, once daily) on clinical efficacy and serum factors in patients with chronic prostatitis (CP). METHODS A retrospective analysis was conducted on 105 patients with CP who received treatment at Hangzhou Lin'an District Hospital of Traditional Chinese Medicine from February 2020 to December 2022. Among them, 47 patients received levofloxacin and tamsulosin were included in a drug group (DG), and 58 patients received additional TENS therapy (frequency: 1/4/1 Hz+80/120/80 Hz; pulse width: 270/230/270 μs+120/80/120 μs; waveform: square and continuous waveforms) were included in a joint group (JG). The changes in the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), international prostate symptom score (IPSS), and the levels of inflammatory and pain-causing factors were compared between the two groups before and after treatment. The clinical efficacy was compared between the two groups after treatment. Moreover, the incidence of adverse reactions was compared between the two groups. RESULTS After treatment, the scores of NIH-CPSI and IPSS, and the levels of IL-6, CRP, TNF-α, IL-1β, 5-hydroxytryptamine, substance P, and dynorphin in the JG were obviously lower than those in the DG (P<0.001). The clinical response rate in the DG was obviously lower than that in the JG (P=0.006, Table 2). There was no difference in total incidence of adverse reactions between the two groups (P=0.801). CONCLUSION Compared to medication alone (levofloxacin and tamsulosin), the combination of TENS with levofloxacin and tamsulosin can reduce the levels of inflammatory and pain-causing factors in patients, and improve the efficacy. Importantly, it has been observed that this combination therapy does not lead to an increase in adverse reactions and is considered to be safe for patients.
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Affiliation(s)
- Guohu Xiao
- Department of Surgical, Hangzhou Lin’an District Hospital of Traditional Chinese MedicineHangzhou 311300, Zhejiang, China
| | - Minjie Weng
- Department of Surgical, Hangzhou Lin’an District Hospital of Traditional Chinese MedicineHangzhou 311300, Zhejiang, China
| | - Ping Wang
- Operating Room, Hangzhou Lin’an District Hospital of Traditional Chinese MedicineHangzhou 311300, Zhejiang, China
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Erkin Y, Hanci V, Ozduran E. Evaluation of the reliability and quality of YouTube videos as a source of information for transcutaneous electrical nerve stimulation. PeerJ 2023; 11:e15412. [PMID: 37492399 PMCID: PMC10364807 DOI: 10.7717/peerj.15412] [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: 12/21/2022] [Accepted: 04/24/2023] [Indexed: 07/27/2023] Open
Abstract
Background YouTube plays an influential role in disseminating health-related information in the digital age. This study aimed to evaluate YouTube videos on transcutaneous electrical nerve stimulation (TENS) in terms of their information value and quality. Methods In this descriptive study, we ranked the first 100 videos that met the inclusion criteria using the search term "transcutaneous electrical nerve stimulation" on October 30, 2022. These videos were classified according to the number of views, likes, dislikes, comments, duration, popularity and content categories. Reliability, quality, and accuracy of the videos were assessed using the Journal of American Medical Association (JAMA) Benchmark Criteria and Modified DISCERN Questionnaire and Global Quality Score (GQS). Video popularity were calculated by the Video Power Index (VPI). Results Based on the GQS results, we found that 59, 27, and 14 videos had low, intermediate, and high quality, respectively. In addition, based on the JAMA results, 79 and 21 videos had poor and high reliability, respectively. No statistically significant difference was found between the JAMA, modified DISCERN and GQS scores in terms of the sources of videos (p = 0.226, p = 0.115, p = 0.812). Notably, there was a weak positive correlation between the JAMA scores and the number of views (r = 0.204, p = 0.041). Conclusion According to our study results, most YouTube videos on TENS were of low quality and reliability. Additionally, most videos were uploaded from sources created by doctors; the most frequently found content was about the TENS procedure, and content on complications of the procedure became less frequent as the videos became more recent. In particular, it was found that videos uploaded by academics have longer duration. It has been found that reliable videos with high JAMA scores also have high number of views. Accordingly, it can be concluded that videos with higher quality and more reliability that are created by healthcare providers will be more useful for patients seeking information about TENS.
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Affiliation(s)
- Yüksel Erkin
- Anesthesiology and Reanimation, Algology, Dokuz Eylül University, Izmir, Turkey
| | - Volkan Hanci
- Anesthesiology and Reanimation, Subdivision of Critical Care Medicine and Resuscitation, Dokuz Eylül University, Izmir, Turkey
| | - Erkan Ozduran
- Physical Medicine and Rehabilitation, Algology, Dokuz Eylül University, Izmir, Turkey
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Zhou Z, Xue Y, Zhao Y, Mu X, Xu L. Effects of microcurrent therapy in promoting function and pain management of knee osteoarthritis: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e069036. [PMID: 37185645 PMCID: PMC10151844 DOI: 10.1136/bmjopen-2022-069036] [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: 05/17/2023] Open
Abstract
INTRODUCTION Microcurrent therapy (MCT) is a rising conservative treatment for patients with knee osteoarthritis (OA). Considering its potential benefits and convenience, MCT's application in those individuals with knee OA is capacious. However, no plausible clinical evidence has proved its unequivocal advantages in treating knee OA conservatively. The purpose of this study is to determine whether MCT is helpful in pain management and promoting function of knee OA and is safe in the treatment of knee OA in adult patients. METHODS AND ANALYSIS We will search through MEDLINE, Embase, Cochrane Library, Web of Science and Google Scholar from inception to 15 March 2023. Original studies will include randomised controlled trials of patients treated with MCT. Two authors will independently screen, select studies, extract data and perform risk of bias assessment. Data consistently reported across studies will be pooled using random-effects meta-analysis. Heterogeneity will be evaluated using Cochrane's Q statistic and quantified using I2 statistics. Graphical and formal statistical tests will be used to assess for publication bias. ETHICS AND DISSEMINATION Ethical approval will not be needed for this study as the data will be extracted from already published studies. The results of this review will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42022319828.
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Affiliation(s)
- Zhuoluo Zhou
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Yuxin Xue
- Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Yi Zhao
- Orthopedics, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Xiaohong Mu
- Orthopedics, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
| | - Lin Xu
- Orthopedics, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, China
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Abd-Elsayed A, Gyorfi M, Fischman M, Odonkor C, Siff B, Cyr K. Reduced Pain and Improved Function Following Short-Term Use of Noninvasive BioWave High Frequency Peripheral Nerve Stimulation for Pain Management. Pain Ther 2023; 12:553-562. [PMID: 36807084 PMCID: PMC10036714 DOI: 10.1007/s40122-023-00480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/25/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION The peripheral nervous system is an increasingly popular target for chronic pain treatment modalities. Noninvasive neuromodulation has shown promise at providing significant chronic pain relief with a much safer side effect profile. This retrospective pilot study is shaped around a noninvasive neuromodulation system over a 2-week treatment timeline. METHODS Open-label survey of chronic pain patients recruited from Veteran Affairs, orthopedic, and pain health systems. If a noninvasive neuromodulation system was prescribed the patients were then offered a 2-week follow-up survey. This voluntary survey did not affect their therapy duration or quality. This survey was designed to address similar metrics as smaller noninvasive neuromodulation studies to allow a quality comparison while giving more power with a large population size of 1511 patients. Overall pain scores (including before and after scores), satisfaction level, desire to continue therapy, medication use, effect on functional metrics (mood, sleep, sit, stand, walk, and lift), and activities of daily living (ADL) scores were assessed. RESULTS The results demonstrated an overall pain reduction of 46%. All functional metrics were improved throughout with the largest improvements reported in mood and sleep at over 47%. Medication use was reported as decreased or eliminated in 42% of patients. There were no adverse reactions or complications reported over the 1511 patients. CONCLUSION This survey is amongst the largest population sizes every studied for noninvasive neuromodulation. Within just 2 weeks patients can see a reduction in overall pain and medication needs. Although survey studies have inherent limitations such as duration and compliance biases with such an overwhelming benefit in every category we believe that noninvasive neuromodulation therapy is a promising, safe, and cost-effective therapy. Future studies should focus on long-term follow-ups and post-therapy pain scores with a placebo group.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA.
| | - Michael Gyorfi
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA
| | | | - Charles Odonkor
- Department of Orthopedics and Rehabilitation, Division of Physiatry, Interventional Pain Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | | | - Kevin Cyr
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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12
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Stark CW, Isaamullah M, Hassan SS, Dyara O, Abd-Elsayed A. A Review of Chronic Pain and Device Interventions: Benefits and Future Directions. Pain Ther 2023; 12:341-354. [PMID: 36581788 PMCID: PMC10036715 DOI: 10.1007/s40122-022-00470-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/01/2022] [Indexed: 12/31/2022] Open
Abstract
Chronic pain is a debilitating condition with a growing prevalence both in the USA and globally. The complex nature of this condition necessitates a multimodal approach to pain management that extends beyond the established pharmaceutical interventions currently employed. A variety of devices comprising both invasive and noninvasive approaches are available to patients, serving as adjuvants to existing regimens. The benefits of these interventions are notable for their lack of addiction potential, potential for patient autonomy regarding self-administration, minimal to no drug interaction, and overall relative safety. However, there remains a need for further research and more robust clinical trials to assess the true efficacy of these interventions and elucidate if there is an underlying physiological mechanism to their benefit in treating chronic pain or if their effect is predominantly placebo in nature. Regardless, the field of device-based intervention and treatment remains an evolving field with much promise for the future chronic pain management.
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Affiliation(s)
- Cain W Stark
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Mir Isaamullah
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | | | - Omar Dyara
- Department of Anesthesiology, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave, Madison, WI, 53726, USA.
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13
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Kutafina E, Becker S, Namer B. Measuring pain and nociception: Through the glasses of a computational scientist. Transdisciplinary overview of methods. FRONTIERS IN NETWORK PHYSIOLOGY 2023; 3:1099282. [PMID: 36926544 PMCID: PMC10013045 DOI: 10.3389/fnetp.2023.1099282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/04/2023] [Indexed: 02/12/2023]
Abstract
In a healthy state, pain plays an important role in natural biofeedback loops and helps to detect and prevent potentially harmful stimuli and situations. However, pain can become chronic and as such a pathological condition, losing its informative and adaptive function. Efficient pain treatment remains a largely unmet clinical need. One promising route to improve the characterization of pain, and with that the potential for more effective pain therapies, is the integration of different data modalities through cutting edge computational methods. Using these methods, multiscale, complex, and network models of pain signaling can be created and utilized for the benefit of patients. Such models require collaborative work of experts from different research domains such as medicine, biology, physiology, psychology as well as mathematics and data science. Efficient work of collaborative teams requires developing of a common language and common level of understanding as a prerequisite. One of ways to meet this need is to provide easy to comprehend overviews of certain topics within the pain research domain. Here, we propose such an overview on the topic of pain assessment in humans for computational researchers. Quantifications related to pain are necessary for building computational models. However, as defined by the International Association of the Study of Pain (IASP), pain is a sensory and emotional experience and thus, it cannot be measured and quantified objectively. This results in a need for clear distinctions between nociception, pain and correlates of pain. Therefore, here we review methods to assess pain as a percept and nociception as a biological basis for this percept in humans, with the goal of creating a roadmap of modelling options.
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Affiliation(s)
- Ekaterina Kutafina
- Institute of Medical Informatics, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Faculty of Applied Mathematics, AGH University of Science and Technology, Krakow, Poland
| | - Susanne Becker
- Clinical Psychology, Department of Experimental Psychology, Heinrich Heine University, Düsseldorf, Germany
- Integrative Spinal Research, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Barbara Namer
- Junior Research Group Neuroscience, Interdisciplinary Center for Clinical Research Within the Faculty of Medicine, RWTH Aachen University, Aachen, Germany
- Institute of Physiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
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14
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Ceballos-Rivera M, González-González Y, Alonso-Calvete A, Justo-Cousiño LA, Da Cuña-Carrera I. [Physiotherapy in the sequelae of cesarean childbirth. A systematic review.]. Rev Esp Salud Publica 2023; 97:e202301002. [PMID: 36636805 PMCID: PMC10541251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Caesarean section is a surgical intervention that consists of the extraction of the fetus by abdominal route through the incision in the uterus. Like any surgical intervention, caesarean section is not exempt from complications and these can be classified as short-term (acute pain) and long-term (adhesions in the scar, lumbar and pelvic pain, intestinal obstruction and ectopic pregnancies). Physiotherapy has different tools to address these complications. The aim of this study was to review the scientific bibliography to know the effects of physiotherapy on patients who have given birth by cesarean section. METHODS A search for articles was carried out during the month of December 2021 in the databases: PubMed, Medline, Cinahl, Scopus, PEDro and WOS using the search terms Cesarean Section, Physical Therapy Modalities and Physical therapy. As an inclusion criterion, it was established that the type of study was a Randomized Clinical Trial (RCT). RESULTS A total of 280 articles were obtained, of which 9 were selected after applying the eligibility criteria. In them, the most used physiotherapy intervention was electrotherapy, followed by massage therapy and therapeutic exercise. Studies show effects of these forms of physiotherapy, with a determined duration and frequency, with improvements in pain, activities of daily living, comfort level, joint ranges and reduction in the consumption of analgesics. CONCLUSIONS Physiotherapy has various modalities with which to attend complications after cesarean section, both in an immediate and a late phase, especially highlighting the reduction of pain.
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Affiliation(s)
| | - Yoana González-González
- Facultade de Fisioterapia, Universidade de Vigo. Pontevedra. España
- Grupo de Investigación Fisioterapia Clínica (FS1), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO. Pontevedra. España
| | - Alejandra Alonso-Calvete
- Facultade de Fisioterapia, Universidade de Vigo. Pontevedra. España
- Grupo de Investigación REMOSS, Universidade de Vigo. Pontevedra. España
| | - Lorenzo A Justo-Cousiño
- Facultade de Fisioterapia, Universidade de Vigo. Pontevedra. España
- Grupo de Investigación Fisioterapia Clínica (FS1), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO. Pontevedra. España
| | - Iria Da Cuña-Carrera
- Facultade de Fisioterapia, Universidade de Vigo. Pontevedra. España
- Grupo de Investigación Fisioterapia Clínica (FS1), Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO. Pontevedra. España
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15
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A Comprehensive Review: Chronic Pain Sequelae in the Presence of Ehlers-Danlos Syndrome. Curr Pain Headache Rep 2022; 26:871-876. [PMID: 36434419 DOI: 10.1007/s11916-022-01093-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Patients diagnosed with Ehlers-Danlos syndromes (EDS), and especially those with the hypermobility subtype, often experience a diverse range of acute and chronic pain conditions throughout their lifetime. These can present in a variety of different phenotypes and comorbidities, making it difficult to develop structured treatment protocols. This review seeks to summarize the current literature to address old and novel treatments for EDS. RECENT FINDINGS Historically, medications and surgery have been used to treat patients with EDS but with low efficacy. Newer therapies that have shown promising effects for both decreasing pain and increasing quality of life include physical/occupational therapy, transcutaneous electrical nerve stimulation units, trigger point injections, low-dose naltrexone, and laser therapy. In addition, addressing the psychosocial aspects of pain with EDS through methods like cognitive behavioral therapy and patient education has shown to be vital in minimizing pain. Most research also emphasizes that pain management should not only focus on pain reduction, but on helping reduce symptoms of hypermobility, central sensitization, and fatigue to make an impactful difference. Research on pain in EDS is still limited with good clinical practice guidelines often limited by poor sample size and lack of clinical studies. Treatment options should be structured based on the specific type of pain pathology and presenting symptoms of each patient and their comorbidities. Future research should attempt to prioritize larger sample sizes, clear definitions of EDS subtypes, randomized trials for treatment efficacy, and more studies dedicated to non-musculoskeletal forms of pain.
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16
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Rogers MJ, Daryoush JR, Kazmers NH. Contemporary Review: Targeted Muscle Reinnervation for Foot and Ankle Applications. Foot Ankle Int 2022; 43:1595-1605. [PMID: 36299247 DOI: 10.1177/10711007221129990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Joshua R Daryoush
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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17
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Managing Chronic Neuropathic Pain: Recent Advances and New Challenges. Neurol Res Int 2022; 2022:8336561. [PMID: 36277331 PMCID: PMC9581623 DOI: 10.1155/2022/8336561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/03/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Aim. Neuropathic pain affects 7–10% of the population, with most of the patients receiving inadequate and incomplete treatment. Owing to the high financial burden and the poor quality of life of the patients and their caretakers, there is a dire need to address the challenges in diagnosing and treating chronic neuropathic pain. Methods. This literature review was conducted to review novel treatments and related challenges through a systematic search from sources such as PubMed, Google Scholar with the combination of MESH words such as neuropathic pain, management of neuropathic pain. Articles from non-English literature, reports without human subjects, animal studies, and abstracts/posters were excluded. However, human studies and studies published in English were included. Result. This review article discusses novel treatment modalities while acknowledging the challenges medical workers face while encountering neuropathic pain. Despite the recent advances in diagnosis and treatment modalities, several challenges still exist. Hence, there is still a need to explore the various treatment modalities, emphasizing the cause and underlying pathophysiology of neuropathic pain. Conclusion. We recommend integrated multimodal treatment with the current treatment facility, including various medical disciplines. However, a personalized approach would work the best depending on the ’patient’s medical history. Therefore, this article recommends an integrated, cause-specific, cost-effective approach to address this problem of chronic neuropathic pain.
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18
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In vivo closed-loop control of a locust's leg using nerve stimulation. Sci Rep 2022; 12:10864. [PMID: 35760828 PMCID: PMC9237135 DOI: 10.1038/s41598-022-13679-z] [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: 10/15/2021] [Accepted: 05/10/2022] [Indexed: 01/17/2023] Open
Abstract
Activity of an innervated tissue can be modulated based on an acquired biomarker through feedback loops. How to convert this biomarker into a meaningful stimulation pattern is still a topic of intensive research. In this article, we present a simple closed-loop mechanism to control the mean angle of a locust’s leg in real time by modulating the frequency of the stimulation on its extensor motor nerve. The nerve is interfaced with a custom-designed cuff electrode and the feedback loop is implemented online with a proportional control algorithm, which runs solely on a microcontroller without the need of an external computer. The results show that the system can be controlled with a single-input, single-output feedback loop. The model described in this article can serve as a primer for young researchers to learn about neural control in biological systems before applying these concepts in advanced systems. We expect that the approach can be advanced to achieve control over more complex movements by increasing the number of recorded biomarkers and selective stimulation units.
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19
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Movahedi M, Ebrahimian M, Saeedy M, Tavoosi N. Comparative study of transcutaneous electrical nerve stimulation, the aromatherapy of Lavandula and physiologic delivery without medication on the neonatal and maternal outcome of patients. INTERNATIONAL JOURNAL OF PHYSIOLOGY, PATHOPHYSIOLOGY AND PHARMACOLOGY 2022; 14:206-210. [PMID: 35891935 PMCID: PMC9301182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The complications of normal vaginal delivery (NVD) are one of the issues that researchers have been discussing today and various ways to reduce these outcomes have been presented. In this study, we aimed to compare the effect of Transcutaneous Electrical Nerve Stimulation (TENS), the aromatherapy of Lavandula and physiologic delivery without medication on NVD outcomes. METHODS This randomized clinical trial was conducted on 150 women that were candidates of NVD. The information related had been registered in the Iranian clinical trial registration system with the code IRCT20210501051151N1 (https://www.irct.ir/trial/56014). Patients were divided into three groups of Lavandula, TENS, and physiologic delivery. Postpartum pain, maternal and neonatal outcomes, and labor duration were compared in groups. RESULTS Labor pain was significantly less in TENS and Lavandula than in the physiologic group, respectively (P<0.001). There was no significant difference between the groups in terms of labor duration and maternal and fetal outcomes. CONCLUSION The use of TENS and Lavandula aromatherapy are useful methods for reducing pain in patients undergoing NVD, but using TENS method is better than Lavandula method, and on the other hand, there are no differences between groups as maternal and neonatal complications.
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Affiliation(s)
- Minoo Movahedi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Maede Ebrahimian
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Milad Saeedy
- School of Medicine, Isfahan University of Medical SciencesIsfahan, Iran
| | - Nooshin Tavoosi
- Department of Midwifery, School of Nursing and Midwifery, Islamic Azad University Shahrekord BranchShahrekord, Iran
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20
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Püsküllüoğlu M, Tomaszewski KA, Grela-Wojewoda A, Pacholczak-Madej R, Ebner F. Effects of Transcutaneous Electrical Nerve Stimulation on Pain and Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: A Systematic Review. Medicina (B Aires) 2022; 58:medicina58020284. [PMID: 35208610 PMCID: PMC8876365 DOI: 10.3390/medicina58020284] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/04/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Transcutaneous electrical nerve stimulation (TENS) is the usage of a mild electrical current through electrodes that stimulate nerves. Patients with malignancies experience pain and chemotherapy-induced peripheral neuropathy. A systematic review was performed to find research evaluating the effect of TENS on these two common symptoms decreasing the quality of life in cancer patients. PubMed, the Cochrane Central Register of Controlled Trials and EMBASE were searched. Original studies, namely randomized controlled trials, quasi-randomized controlled trials and controlled clinical trials, published between April 2007 and May 2020, were considered. The quality of the selected studies was assessed. Seven papers were incorporated in a qualitative synthesis, with 260 patients in total. The studies varied in terms of design, populations, endpoints, quality, treatment duration, procedures and follow-up period. Based on the results, no strict recommendations concerning TENS usage in the cancer patient population could be issued. However, the existing evidence allows us to state that TENS is a safe procedure that may be self-administered by the patients with malignancy in an attempt to relieve different types of pain. There is a need for multi-center, randomized clinical trials with a good methodological design and adequate sample size.
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Affiliation(s)
- Mirosława Püsküllüoğlu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
- Labcorp (Polska) Sp. z o.o., 05-825 Warsaw, Poland
- Correspondence:
| | - Krzysztof A. Tomaszewski
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland;
- Scanmed St. Raphael Hospital, 30-693 Krakow, Poland
| | - Aleksandra Grela-Wojewoda
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
| | - Renata Pacholczak-Madej
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, 00-001 Krakow, Poland; (A.G.-W.); (R.P.-M.)
- Department of Anatomy, Medical College, Jagiellonian University, 31-008 Krakow, Poland
| | - Florian Ebner
- Helios Amper-Klinikum Dachau, Akademisches Lehrkrankenhaus der Ludwig-Maximilians-Universität, 85221 München, Germany;
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21
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Kibuka M, Price A, Onakpoya I, Tierney S, Clarke M. Evaluating the effects of maternal positions in childbirth: An overview of Cochrane Systematic Reviews. Eur J Midwifery 2022; 5:57. [PMID: 35005482 PMCID: PMC8678923 DOI: 10.18332/ejm/142781] [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: 07/19/2021] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The purpose of this study is to conduct an overview of Cochrane systematic reviews (SRs) evaluating the effects of maternal positions in childbirth in order to compile existing evidence for relevant research questions that have been addressed by more than one review, to provide a succinct summary of the up-to-date evidence and to identify areas for future research. METHODS An electronic search was conducted in the Cochrane database. Two primary outcomes were the duration of labor and birth, and operative birth. The quality of included reviews was assessed using the AMSTAR criteria, and the quality of the evidence was rated using the GRADE criteria. RESULTS We included 3 Cochrane SRs. There was a significant mean difference (MD) found in the duration of the first stage by 1 hour and 22 minutes (MD= -1.21; 95% CI: -2.35 – -0.07, I2=94%) and reduction in caesarean section rates (RR=0.71; 95% CI: 0.54–0.94, I2=0%) in the upright birth position group compared with the horizontal. Also, there was a statistically significant difference in the duration (minutes) of the second stage of labor (MD= -6.16; 95% CI: -9.74 – -2.59, I2=91%) and a reduction in assisted vaginal birth rates (RR=0.75, 95% CI: 0.66–0.86, I2=29%) in the upright group compared with the horizontal without epidural analgesia. The quality of evidence within the reviews was very low to moderate. CONCLUSIONS There is currently a limited body of evidence to clearly assess the benefits and risks of assuming upright positions during childbirth. The overview highlights the need for high-quality research studies, involving better definition and comprehensive assessment of the effects of squatting during childbirth.
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Affiliation(s)
- Marion Kibuka
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Amy Price
- Stanford Anesthesia and Informatics Media Lab, School of Medicine, Stanford University, Palo Alto, United States.,Centre for Evidence Based Medicine, University of Oxford, Oxford, United Kingdom
| | - Igho Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, United Kingdom
| | - Stephanie Tierney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mike Clarke
- All Ireland Hub for Trials Methodology Research, Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Royal Victoria Hospital, Belfast, Ireland
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22
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Jadidi AF, Stevenson AJT, Zarei AA, Jensen W, Lontis R. Effect of Modulated TENS on Corticospinal Excitability in Healthy Subjects. Neuroscience 2022; 485:53-64. [PMID: 35031397 DOI: 10.1016/j.neuroscience.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Conventional transcutaneous electrical nerve stimulation (TENS) has been reported to effectively alleviate chronic pain, including phantom limb pain (PLP). Recently, literature has focused on modulated TENS patterns, such as pulse width modulation (PWM) and burst modulation (BM), as alternatives to conventional, non-modulated (NM) sensory neurostimulation to increase the efficiency of rehabilitation. However, there is still limited knowledge of how these modulated TENS patterns affect corticospinal (CS) and motor cortex activity. Therefore, our aim was to first investigate the effect of modulated TENS patterns on CS activity and corticomotor map in healthy subjects. Motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) were recorded from three muscles before and after the application of TENS interventions. Four different TENS patterns (PWM, BM, NM 40 Hz, and NM 100 Hz) were applied. The results revealed significant facilitation of CS excitability following the PWM intervention. We also found an increase in the volume of the motor cortical map following the application of the PWM and NM (40 Hz). Although PLP alleviation has been reported to be associated with an enhancement of corticospinal excitability, the efficiency of the PWM intervention to induce pain alleviation should be validated in a future clinical study in amputees with PLP.
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Affiliation(s)
- Armita Faghani Jadidi
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark.
| | | | - Ali Asghar Zarei
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
| | - Winnie Jensen
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
| | - Romulus Lontis
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
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23
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Considerations for lactation with Ehlers-Danlos syndrome: a narrative review. Int Breastfeed J 2022; 17:4. [PMID: 34983567 PMCID: PMC8725515 DOI: 10.1186/s13006-021-00442-9] [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: 04/23/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
Background Ehlers-Danlos syndrome (EDS) is a rare genetic connective tissue condition that is poorly understood in relation to lactation. As diagnostic methods improve, prevalence has increased. EDS, a disorder that impacts connective tissue, is characterized by skin extensibility, joint hypermobility, and fragile tissue which can affect every organ and body system leading to complications during pregnancy, delivery, and the postpartum period. Traits of this disease can cause mild to severe physiologic and functional obstacles during lactation. Unfortunately, there is little clinical evidence and minimal guidance for lactation management, and providers may feel uncomfortable and hesitant to address these concerns with patients due to a lack of readily available resources on the subject and inexperience with such patients. This narrative review describes and discusses the types of EDS, identifying symptoms, considerations, and precautions for care providers to implement during lactation and breastfeeding. Methods An electronic search of relevant citations was conducted using the databases Cochrane, PubMed, and Google Scholar from 1 January 2000 to 1 November 2021. Search terms used were Ehlers-Danlos syndrome, Hypermobility Syndrome, breastfeeding, lactation, breastmilk expression, breastmilk collection, human milk expression, human milk collection, and infant feeding. The search of these databases yielded zero results. As no research articles on EDS were directly related to lactation, this narrative review includes articles found that related to the health of mothers relevant to maternal function during lactation. Discussion For the healthcare provider, identifying characteristics of EDS can improve the management of lactation challenges. Mothers may experience generalized symptoms from gastrointestinal distress to fatigue or chronic pain, while they also may suffer from more specific joint complaints and injuries, such as dislocations / subluxations, or skin fragility. Such obstacles can generate impediments to breastfeeding and create unique challenges for breastfeeding mothers with EDS. Unfortunately, new mothers with these symptoms may have them overlooked or not addressed, impacting a mother’s ability to meet her breastfeeding intentions. While there are some published research manuscripts on EDS and pregnancy, there is a lack of information regarding breastfeeding and lactation. Additional research is needed to help guide EDS mothers to achieve their breastfeeding intentions.
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Lara-Palomo IC, Antequera-Soler E, Matarán-Peñarrocha GA, Fernández-Sánchez M, García-López H, Castro-Sánchez AM, Aguilar-Ferrándiz ME. Comparison of the effectiveness of an e-health program versus a home rehabilitation program in patients with chronic low back pain: A double blind randomized controlled trial. Digit Health 2022; 8:20552076221074482. [PMID: 35111332 PMCID: PMC8801654 DOI: 10.1177/20552076221074482] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/03/2022] [Indexed: 12/26/2022] Open
Abstract
OBJETIVE We conducted a randomized double blind clinical trial, to compare the effectiveness of McKenzie exercises and electroanalgesia via an e-Health program versus a home rehabilitation program on functionality, pain, fear of movement and quality of life in patients with non-specific chronic low back pain. METHODS Seventy-four participants with non-specific chronic low back pain were randomized to either the e- Health program group (n = 39) or the home rehabilitation program group (n = 35). The interventions consisted of the e-Health program group performing McKenzie exercises and received transcutaneous electrical nerve stimulation, while the home rehabilitation group attended an information session to explain the exercises, which they then performed at home with printed instructions. Both groups performed 3 weekly sessions for 8 weeks. The following were analyzed main measures: pain, disability, fear of movement, quality of life, trunk muscle endurance and trunk anteflexion motion were assessed at baseline and at 2 months. RESULTS Independent samples Student's t-tests showed that although the patients who followed the e-Health program showed significantly greater improvement than those who followed the home disability rehabilitation program in terms of intensity of pain, lumbar flexion mobility (P < 0.001), and the following dimensions of quality of life (P < 0.005), both groups improved significantly in the immediate post-treatment follow up compared with baseline scores. CONCLUSIONS Patients with chronic low back pain who followed an unsupervised home intervention supported by an individualized video exercise program showed greater post-treatment improvement than those who followed the same program with printed instructions.
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Affiliation(s)
| | - Eduardo Antequera-Soler
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almería, Andalucía, Spain
| | | | - Manuel Fernández-Sánchez
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almería, Andalucía, Spain
| | - Héctor García-López
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almería, Andalucía, Spain
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Rigoard P, Ounajim A, Goudman L, Bouche B, Roulaud M, Page P, Lorgeoux B, Baron S, Nivole K, Many M, Adjali N, Charrier E, Rannou D, Poupin L, Wood C, David R, Héraud D, Moens M, Billot M. The Added Value of Subcutaneous Peripheral Nerve Field Stimulation Combined with SCS, as Salvage Therapy, for Refractory Low Back Pain Component in Persistent Spinal Pain Syndrome Implanted Patients: A Randomized Controlled Study (CUMPNS Study) Based on 3D-Mapping Composite Pain Assessment. J Clin Med 2021; 10:5094. [PMID: 34768614 PMCID: PMC8584602 DOI: 10.3390/jcm10215094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/13/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
While Spinal Cord Stimulation (SCS) provides satisfaction to almost 2/3 of Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients implanted for refractory chronic back and/or leg pain, when not adequately addressed the back pain component, leaves patients in a therapeutic cul-de-sac. Peripheral Nerve field Stimulation (PNfS) has shown interesting results addressing back pain in the same population. Far from placing these two techniques in opposition, we suggest that these approaches could be combined to better treat PSPS-T2 patients. We designed a RCT (CUMPNS), with a 12-month follow-up, to assess the potential added value of PNfS, as a salvage therapy, in PSPS-T2 patients experiencing a "Failed SCS Syndrome" in the back pain component. Fourteen patients were included in this study and randomized into 2 groups ("SCS + PNfS" group/n = 6 vs. "SCS only" group/n = 8). The primary objective of the study was to compare the percentage of back pain surface decrease after 3 months, using a computerized interface to obtain quantitative pain mappings, combined with multi-dimensional SCS outcomes. Back pain surface decreased significantly greater for the "SCS + PNfS" group (80.2% ± 21.3%) compared to the "SCS only" group (13.2% ± 94.8%) (p = 0.012), highlighting the clinical interest of SCS + PNfS, in cases where SCS fails to address back pain.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
- Department of Spine Surgery & Neuromodulation, Poitiers University Hospital, 86021 Poitiers, France
- Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, 86360 Chasseneuil-du-Poitou, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Benedicte Bouche
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Philippe Page
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Bertille Lorgeoux
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Sandrine Baron
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Kevin Nivole
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Mathilde Many
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Nihel Adjali
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Elodie Charrier
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Delphine Rannou
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Laure Poupin
- Pain Evaluation and Treatment Centre, Poitiers University Hospital, 86021 Poitiers, France; (E.C.); (D.R.); (L.P.)
| | - Chantal Wood
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Romain David
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
- Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, 86021 Poitiers, France
| | - Dylan Héraud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
| | - Maartens Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium; (L.G.); (M.M.)
- STIMULUS Research Group, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, 86021 Poitiers, France; (A.O.); (B.B.); (M.R.); (B.L.); (S.B.); (K.N.); (M.M.); (N.A.); (C.W.); (R.D.); (D.H.)
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Khalafalla K, Arafa M, Elbardisi H, Majzoub A. Non-pharmacological treatments for chronic orchialgia: A systemic review. Arab J Urol 2021; 19:401-410. [PMID: 34552792 PMCID: PMC8451689 DOI: 10.1080/2090598x.2021.1958469] [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] [Indexed: 11/03/2022] Open
Abstract
Objective : To review the outcomes of various therapeutic modalities that can be offered to patients with chronic orchialgia (CO) after failed conservative treatment. Methods : A literature search was conducted using the PubMed and MEDLINE databases searching for articles exploring different CO treatment modalities. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used to report the results of the literature search. Results : A total of 34 studies were included for qualitative analysis. Most of the studies explored microsurgical spermatic cord denervation (MSCD; n = 19). Eight studies involved devices and interventions directed at blocking nerve sensations (pulsed radiofrequency stimulation, n = 5; transcutaneous electrical nerve stimulation, n = 1; cryoablation, n = 1; and mechanical vibratory stimulation, n = 1). Five studies reported on vasectomy reversal as a modality to relieve post-vasectomy pain syndrome (PVPS), while two studies explored the outcomes of orchidectomy on pain relief in patients with CO. Conclusion : Several treatment methods are available in the urologist’s armamentarium for the treatment of CO. MSCD appears to be an appealing treatment modality with encouraging outcomes. Neuropathic pain can be managed with a number of relatively non-invasive modalities. Vasectomy reversal is a sound treatment approach for patients with PVPS and ultimately orchidectomy is a terminal approach that can be discussed with patients suffering from intractable pain.
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Affiliation(s)
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, CL, OH, USA.,Andrology Department, Cario University, Cairo, Egypt
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, CL, OH, USA
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
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27
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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: 5] [Impact Index Per Article: 1.7] [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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28
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Tonye-Geoffroy L, Mauboussin Carlos S, Tuffet S, Fromentin H, Berard L, Leblanc J, Laroche F. Efficacy of a combination of hypnosis and transcutaneous electrical nerve stimulation for chronic non-cancer pain: A randomized controlled trial. J Adv Nurs 2021; 77:2875-2886. [PMID: 33783846 PMCID: PMC8251595 DOI: 10.1111/jan.14833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Chronic non-cancer pain, which persists for at least three months, seriously affects quality of life. Chronic non-cancer pain patients are usually managed by a multidisciplinary team using pharmacological and non-pharmacological strategies. Nurses perform transcutaneous electrical nerve stimulation (TENS) and hypnosis, which are widely used in France for the treatment of chronic pain in pain departments. OBJECTIVE To assess pain relief at three months, comparing a simultaneous combination of hypnosis and TENS (intervention) with TENS alone (control). DESIGN Randomized controlled trial. METHODS Patients aged 18-80 years, suffering from chronic peripheral neuropathic and/or nociceptive non-cancer pain were included (September 2013 to May 2017) and followed for six months. The primary outcome was the pain intensity difference (by visual analog scale score) between month 3 and baseline. The secondary outcomes, assessed at months 3 and 6, were SF36 score, analgesics consumption and number of TENS sessions performed at home (last seven days). RESULTS Seventy-two patients were included, suffering from a combination of chronic non-cancer nociceptive and neuropathic pain, with a mean pain intensity of about sixty out of a hundred. The results show an important pain reduction (forty percent) in both groups at 3 months. No significant difference was observed between the control and intervention groups. Similarly, SF36 score, change in analgesic intake and patient compliance did not differ significantly between groups. CONCLUSIONS This is the first randomized controlled study showing a decrease of pain intensity and a high level of compliance with transcutaneous electrical nerve stimulation alone or associated to hypnosis. The combination does not seem to be more efficient than transcutaneous electrical nerve stimulation alone. Chronic non-cancer pain remains a major issue and a substantial proportion of patients do not appear to benefit from interventions. IMPACT This study increases our understanding of the combination of two non-pharmacological methods in chronic non-cancer pain patients. The combination of the two non-pharmacological strategies did not appear to be more efficient than one alone. Further research on non-pharmacological treatments targeting to patient's characteristics are needed to find appropriate strategies in patients with complex multidimensional pain conditions. Clinical Trial Number: NCT01944150 (Sept. 17, 2013).
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Affiliation(s)
- Louise Tonye-Geoffroy
- Assistance Publique - Hôpitaux de Paris (AP-HP), Pain Department of Saint-Antoine University Hospital and Medical University Sorbonne, Hôpital Saint-Antoine, Paris, France
| | - Stéphanie Mauboussin Carlos
- Assistance Publique - Hôpitaux de Paris (AP-HP), Pain Department of Saint-Antoine University Hospital and Medical University Sorbonne, Hôpital Saint-Antoine, Paris, France
| | - Sophie Tuffet
- Assistance Publique - Hôpitaux de Paris (AP-HP), AP-HP.Sorbonne Université, Clinical Research Unit of East of Paris (URC-Est), Paris, France
| | - Hélène Fromentin
- Assistance Publique - Hôpitaux de Paris (AP-HP), AP-HP.Sorbonne Université, Clinical Research Center of East of Paris (CRC-Est), Paris, France
| | - Laurence Berard
- Assistance Publique - Hôpitaux de Paris (AP-HP), AP-HP.Sorbonne Université, Clinical Research Platform of East of Paris (URC-Est/CRC-Est), Paris, France
| | - Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), AP-HP.Sorbonne Université, Clinical Research Center of East of Paris (CRC-Est), Paris, France
| | - Françoise Laroche
- Assistance Publique - Hôpitaux de Paris (AP-HP), Pain Department of Saint-Antoine University Hospital and Medical University Sorbonne, Hôpital Saint-Antoine, Paris, France.,Musculoskeletal Pain Group - INSERM U987 - Ambroise Paré Hospital, Boulogne Billancourt, France
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29
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Mo J, Priefer R. Medical Devices for Tremor Suppression: Current Status and Future Directions. BIOSENSORS-BASEL 2021; 11:bios11040099. [PMID: 33808056 PMCID: PMC8065649 DOI: 10.3390/bios11040099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 01/14/2023]
Abstract
Tremors are the most prevalent movement disorder that interferes with the patient’s daily living, and physical activities, ultimately leading to a reduced quality of life. Due to the pathophysiology of tremor, developing effective pharmacotherapies, which are only suboptimal in the management of tremor, has many challenges. Thus, a range of therapies are necessary in managing this progressive, aging-associated disorder. Surgical interventions such as deep brain stimulation are able to provide durable tremor control. However, due to high costs, patient and practitioner preference, and perceived high risks, their utilization is minimized. Medical devices are placed in a unique position to bridge this gap between lifestyle interventions, pharmacotherapies, and surgical treatments to provide safe and effective tremor suppression. Herein, we review the mechanisms of action, safety and efficacy profiles, and clinical applications of different medical devices that are currently available or have been previously investigated for tremor suppression. These devices are primarily noninvasive, which can be a beneficial addition to the patient’s existing pharmacotherapy and/or lifestyle intervention.
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30
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Arendsen LJ, Guggenberger R, Zimmer M, Weigl T, Gharabaghi A. Peripheral Electrical Stimulation Modulates Cortical Beta-Band Activity. Front Neurosci 2021; 15:632234. [PMID: 33867919 PMCID: PMC8044771 DOI: 10.3389/fnins.2021.632234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Low-frequency peripheral electrical stimulation using a matrix electrode (PEMS) modulates spinal nociceptive pathways. However, the effects of this intervention on cortical oscillatory activity have not been assessed yet. The aim of this study was to investigate the effects of low-frequency PEMS (4 Hz) on cortical oscillatory activity in different brain states in healthy pain-free participants. In experiment 1, PEMS was compared to sham stimulation. In experiment 2, motor imagery (MI) was used to modulate the sensorimotor brain state. PEMS was applied either during MI-induced oscillatory desynchronization (concurrent PEMS) or after MI (delayed PEMS) in a cross-over design. For both experiments, PEMS was applied on the left forearm and resting-state electroencephalography (EEG) was recording before and after each stimulation condition. Experiment 1 showed a significant decrease of global resting-state beta power after PEMS compared to sham (p = 0.016), with a median change from baseline of −16% for PEMS and −0.54% for sham. A cluster-based permutation test showed a significant difference in resting-state beta power comparing pre- and post-PEMS (p = 0.018) that was most pronounced over bilateral central and left frontal sensors. Experiment 2 did not identify a significant difference in the change from baseline of global EEG power for concurrent PEMS compared to delayed PEMS. Two cluster-based permutation tests suggested that frontal beta power may be increased following both concurrent and delayed PEMS. This study provides novel evidence for supraspinal effects of low-frequency PEMS and an initial indication that the presence of a cognitive task such as MI may influence the effects of PEMS on beta activity. Chronic pain has been associated with changes in beta activity, in particular an increase of beta power in frontal regions. Thus, brain state-dependent PEMS may offer a novel approach to the treatment of chronic pain. However, further studies are warranted to investigate optimal stimulation conditions to achieve a reduction of pain.
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Affiliation(s)
- Laura J Arendsen
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Robert Guggenberger
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Manuela Zimmer
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Tobias Weigl
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
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31
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Sean M, Coulombe-Lévêque A, Vincenot M, Martel M, Gendron L, Marchand S, Léonard G. Transcutaneous electrical nerve stimulation (TENS): towards the development of a clinic-friendly method for the evaluation of excitatory and inhibitory pain mechanisms. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2021; 5:56-65. [PMID: 34189390 PMCID: PMC8210867 DOI: 10.1080/24740527.2020.1862624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background: Temporal summation and conditioned pain modulation (CPM) can be measured using a thermode and cold pressor test (CPTest). Unfortunately, these complex and expensive tools are ill-suited for routine clinical assessments. Aims: We aimed to compare the temporal summation and CPM obtained with the thermode + CPTest paradigm to those obtained with a novel paradigm using transcutaneous electrical nerve stimulation (TENS). Methods: We assessed temporal summation and CPM in 29 healthy participants, using two paradigms (random order): TENS, and thermode + CPTest. In the TENS paradigm, both the conditioning stimulus (CS) and the test stimulus (TS) were delivered using TENS; in the thermode + CPTest paradigm, the CS consisted of a CPTest and the TS was delivered using a thermode. We compared the average temporal summation and CPM evoked by the two paradigms. Results: Average temporal summation was similar for both modalities (P = 0.90), and the number of participants showing temporal summation was similar in both paradigms (19 with thermode vs. 18 with TENS; P = 1.00). Average CPM response was larger following the thermode + CPTest than following the TENS (P = 0.005), and more participants showed CPM with the thermode + CPTest paradigm compared to the TENS paradigm (24 vs. 14; P = 0.01). Conclusions: Both paradigms were roughly equivalent in the ability to evoke temporal summation (although response to one modality did not predict response to the other), but the TENS paradigm appeared to be less apt to induce a CPM response than the thermode + CPTest paradigm.
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Affiliation(s)
- Monica Sean
- Research Centre on Aging, Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alexia Coulombe-Lévêque
- Research Centre on Aging, Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Matthieu Vincenot
- Research Centre on Aging, Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marylie Martel
- Research Centre on Aging, Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Louis Gendron
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada.,Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Serge Marchand
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada.,Department of Neurosurgery, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Guillaume Léonard
- Research Centre on Aging, Sherbrooke, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Euler L, Guo L, Persson NK. Textile Electrodes: Influence of Knitting Construction and Pressure on the Contact Impedance. SENSORS (BASEL, SWITZERLAND) 2021; 21:1578. [PMID: 33668250 PMCID: PMC7956463 DOI: 10.3390/s21051578] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
Textile electrodes, also called textrodes, for biosignal monitoring as well as electrostimulation are central for the emerging research field of smart textiles. However, so far, only the general suitability of textrodes for those areas was investigated, while the influencing parameters on the contact impedance related to the electrode construction and external factors remain rather unknown. Therefore, in this work, six different knitted electrodes, applied both wet and dry, were compared regarding the influence of specific knitting construction parameters on the three-electrode contact impedance measured on a human forearm. Additionally, the influence of applying pressure was investigated in a two-electrode setup using a water-based agar dummy. Further, simulation of an equivalent circuit was used for quantitative evaluation. Indications were found that the preferred electrode construction to achieve the lowest contact impedance includes a square shaped electrode, knitted with a high yarn density and, in the case of dry electrodes, an uneven surface topography consisting of loops, while in wet condition a smooth surface is favorable. Wet electrodes are showing a greatly reduced contact impedance and are therefore to be preferred over dry ones; however, opportunities are seen for improving the electrode performance of dry electrodes by applying pressure to the system, thereby avoiding disadvantages of wet electrodes with fluid administration, drying-out of the electrolyte, and discomfort arising from a "wet feeling".
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Affiliation(s)
- Luisa Euler
- Polymeric E-Textiles, Department of Textile Technology, University of Borås, SE-501 90 Borås, Sweden; (L.E.); (L.G.)
- Smart Textiles Technology Lab, Smart Textiles, University of Borås, SE-501 90 Borås, Sweden
| | - Li Guo
- Polymeric E-Textiles, Department of Textile Technology, University of Borås, SE-501 90 Borås, Sweden; (L.E.); (L.G.)
| | - Nils-Krister Persson
- Polymeric E-Textiles, Department of Textile Technology, University of Borås, SE-501 90 Borås, Sweden; (L.E.); (L.G.)
- Smart Textiles Technology Lab, Smart Textiles, University of Borås, SE-501 90 Borås, Sweden
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Xu X, Zhang H, Yan Y, Wang J, Guo L. Effects of electrical stimulation on skin surface. ACTA MECHANICA SINICA = LI XUE XUE BAO 2021; 37:1843-1871. [PMID: 33584001 PMCID: PMC7866966 DOI: 10.1007/s10409-020-01026-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 05/10/2023]
Abstract
ABSTRACT Skin is the largest organ in the body, and directly contact with the external environment. Articles on the role of micro-current and skin have emerged in recent years. The function of micro-current is various, including introducing various drugs into the skin locally or throughout the body, stimulating skin wounds healing through various currents, suppressing pain caused by various diseases, and promoting blood circulation for postoperative muscle rehabilitation, etc. This article reviews these efforts. Compared with various physical and chemical medical therapies, micro-current stimulation provides a relatively safe, non-invasive therapy with few side effects, giving modern medicine a more suitable treatment option. At the same time, the cost of the electrical stimulation generating device is relatively low, which makes it have wider space to and more clinical application value. The current micro-current stimulation technology has become more and more mature, but there are still many problems in its research. The design of the experiment and the selection of the current parameters not standardized and rigorous. Now, clear regulations are needed to regulate this field. Micro-current skin therapy has become a robust, reliable, and well-structured system.
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Affiliation(s)
- Xinkai Xu
- State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190 China
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049 China
| | - Han Zhang
- School of Engineering Science, University of Chinese Academy of Sciences, Beijing, 100049 China
- Key Laboratory of Noise and Vibration, Institute of Acoustics, Chinese Academy of Sciences, Beijing, 100190 China
- State Key Laboratory of Acoustics, Institute of Acoustics, Chinese Academy of Sciences, Beijing, 100190 China
| | - Yan Yan
- Cosmetic Technology Center, Chinese Academy of Inspection and Quarantine, Beijing, 100176 China
| | - Jianru Wang
- Xi’an Aerospace Propulsion Institute, Xi’an, 710100 China
| | - Liang Guo
- State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, 100190 China
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Siemens W, Boehlke C, Bennett MI, Offner K, Becker G, Gaertner J. Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care-a blinded, randomized, sham-controlled pilot cross-over trial. Support Care Cancer 2020; 28:5323-5333. [PMID: 32128614 PMCID: PMC7547037 DOI: 10.1007/s00520-020-05370-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/19/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Transcutaneous electrical nerve stimulation (TENS) is a treatment option for cancer pain, but the evidence is inconclusive. We aimed to evaluate the efficacy and safety of TENS. METHODS A blinded, randomized, sham-controlled pilot cross-over trial (NCT02655289) was conducted on an inpatient specialist palliative care ward. We included adult inpatients with cancer pain ≥ 3 on an 11-point numerical rating scale (NRS). Intensity-modulated high TENS (IMT) was compared with placebo TENS (PBT). Patients used both modes according to their preferred application scheme during 24 h with a 24-h washout phase. The primary outcome was change in average pain intensity on the NRS during the preceding 24 h. Responders were patients with at least a "slight improvement." RESULTS Of 632 patients screened, 25 were randomized (sequence IMT-PBT = 13 and PBT-IMT = 12). Finally, 11 patients in IMT-PBT and 9 in PBT-IMT completed the study (N = 20). The primary outcome did not differ between groups (IMT minus PBT: - 0.2, 95% confidence interval - 0.9 to 0.6). However, responder rates were higher in IMT (17/20 [85%] vs. 10/20 [50%], p = 0.0428). Two patients experienced an uncomfortable feeling caused by the current, one after IMT and one after PBT. Seven patients (35%) desired a TENS prescription. Women and patients with incident pain were most likely to benefit from TENS. CONCLUSION TENS was safe, but IMT was unlikely to offer more analgesic effects than PBT. Even though many patients desired a TENS prescription, 50% still reported at least "slight pain relief" from PBT. Differences for gender and incident pain aspects demand future trials.
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Affiliation(s)
- Waldemar Siemens
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany.
| | - Christopher Boehlke
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Klaus Offner
- Department of Anesthesiology and Critical Care, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gerhild Becker
- Clinic for Palliative Care, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str 3, 79106, Freiburg, Germany
| | - Jan Gaertner
- Center for Palliative Care Hildegard, Basel, Switzerland
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Fuentes Aracena C. Rol de los agentes físicos en la rehabilitación vocal: una revisión de la literatura. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2020. [DOI: 10.5209/rlog.65341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Los agentes físicos son elementos naturales o artificiales que se aplican para el tratamiento de determinados síntomas o patologías. En la rehabilitación vocal su estudio es un área emergente, donde las revisiones sistemáticas y los meta-análisis son escasos. Esto, muchas veces, dificulta la toma de decisiones y la correcta elección por parte del clínico. El objetivo de este trabajo fue analizar el rol de los agentes físicos en la rehabilitación vocal. Se realizó una revisión de la literatura a través de la búsqueda de artículos en las bases de datos PubMed, EBSCOHost y Scielo. Se establecieron criterios de elegibilidad según tipo, año y características de los estudios. Se evaluaron 603 artículos, de los cuales, luego del análisis de su título, abstract y del cumplimiento de los criterios de elegibilidad, se seleccionaron 16. Se entregan resultados en base a la cantidad de participantes, nivel de evidencia, tipo y configuración del agente físico, procedimientos e instrumentos de evaluación y beneficios obtenidos. Los agentes físicos de mayor utilización en la clínica vocal son la electroterapia (TENS y NMES) y la laserterapia. En general, estos actúan como coadyuvantes en la terapia vocal. La TENS reduce el dolor, la tensión laríngea y la percepción de voz apretada durante la fonación. La NMES beneficia la activación neuromuscular de las cuerdas vocales y el uso de láser permite la recuperación de los tejidos laríngeos posterior a tareas de sobrecarga.
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Schaffler-Schaden D, Sassmann R, Johansson T, Gampenrieder SP, Rinnerthaler G, Lampl K, Herfert J, Lenzhofer C, Landkammer YT, Rieder F, Greil R, Flamm M, Niebauer J. Comparison of high tone therapy and transcutaneous electrical nerve stimulation therapy in chemotherapy-induced polyneuropathy. Medicine (Baltimore) 2020; 99:e20149. [PMID: 32384502 PMCID: PMC7220357 DOI: 10.1097/md.0000000000020149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Chemotherapy-induced peripheral neuropathy (CIPN) is a worldwide concern in patients receiving neurotoxic agents for cancer therapy. High tone external muscle stimulation is a promising therapeutic approach to alleviate symptoms of CIPN. METHODS This pilot study aims to investigate whether the application of home-based high-tone external muscle stimulation therapy (HTEMS) improves symptoms of CIPN. The trial is planned as a therapist- and assessor-blinded, 1:1 randomized controlled study. A total of 50 patients with chemotherapy-induced peripheral polyneuropathy will be included. All patients will perform therapy at home. Study participants will be allocated randomly to the HTEMS therapy (intervention group) or to the transcutaneous electrical nerve stimulation (TENS, control group), respectively, following a standardized therapy schedule. Compliance of participants can be verified by reading out the tool box. Outcomes will be evaluated at baseline and after 8 weeks of home-based therapy. The primary outcome includes improvement of CIPN according to the patient-reported EORTC QLQ-CIPN 20 questionnaire. Secondary outcomes are the patient-reported change in health-related quality of life and clinician-reported changes of vibration sensibility, tendon reflexes, temperature sensibility, perception of touch, and strength of the lower leg muscles. Further a safety- and process evaluation will be performed. DISCUSSION This pilot RCT aims to evaluate the impact of home-based HTEMS as compared to TENS in CIPN. There is a need for an effective treatment for CIPN and the results of this study are expected to possibly identify a novel and effective treatment strategy in the future.
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Affiliation(s)
| | | | - Tim Johansson
- Institute of General Practice, Family Medicine and Preventive Medicine
| | - Simon P. Gampenrieder
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR)
| | - Gabriel Rinnerthaler
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR)
| | | | | | | | | | | | - Richard Greil
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Salzburg Cancer Research Institute - Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR)
| | - Maria Flamm
- Institute of General Practice, Family Medicine and Preventive Medicine
| | - Josef Niebauer
- Institute of Physical Medicine and Rehabilitation
- Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Austria
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Sato KL, Sanada LS, Silva MDD, Okubo R, Sluka KA. Transcutaneous electrical nerve stimulation, acupuncture, and spinal cord stimulation on neuropathic, inflammatory and, non-inflammatory pain in rat models. Korean J Pain 2020; 33:121-130. [PMID: 32235012 PMCID: PMC7136295 DOI: 10.3344/kjp.2020.33.2.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/01/2019] [Accepted: 12/15/2019] [Indexed: 01/05/2023] Open
Abstract
Background Transcutaneous electrical nerve stimulation (TENS), manual acupuncture (MA), and spinal cord stimulation (SCS) are used to treat a variety of pain conditions. These non-pharmacological treatments are often thought to work through similar mechanisms, and thus should have similar effects for different types of pain. However, it is unclear if each of these treatments work equally well on each type of pain condition. The purpose of this study was to compared the effects of TENS, MA, and SCS on neuropathic, inflammatory, and non-inflammatory pain models. Methods TENS 60 Hz, 200 μs, 90% motor threshold (MT), SCS was applied at 60 Hz, an intensity of 90% MT, and a 0.25 ms pulse width. MA was performed by inserting a stainless-steel needle to a depth of about 4-5 mm at the Sanyinjiao (SP6) and Zusanli (ST36) acupoints on a spared nerve injury (SNI), knee joint inflammation (3% carrageenan), and non-inflammatory muscle pain (intramuscular pH 4.0 injections) in rats. Mechanical withdrawal thresholds of the paw, muscle, and/or joint were assessed before and after induction of the pain model, and daily before and after treatment. Results The reduced withdrawal thresholds were significantly reversed by application of either TENS or SCS (P < 0.05). MA, on the other hand, increased the withdrawal threshold in animals with SNI and joint inflammation, but not chronic muscle pain. Conclusions TENS and SCS produce similar effects in neuropathic, inflammatory and non-inflammatory muscle pain models while MA is only effective in inflammatory and neuropathic pain models.
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Affiliation(s)
- Karina Laurenti Sato
- Department of Physical Therapy, Federal University of Sergipe, Sao Cristovao, Brazil
| | - Luciana Sayuri Sanada
- Department of Physical Therapy, Physiotherapy Postgraduate Program, Santa Catarina State University, Florianopolis, Brazil
| | | | - Rodrigo Okubo
- Department of Physical Therapy, Physiotherapy Postgraduate Program, Santa Catarina State University, Florianopolis, Brazil
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, Iowa City, IA, USA
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Peacock KS, Stoerkel E, Libretto S, Zhang W, Inman A, Schlicher M, Cowsar JD, Eddie D, Walter J. A randomized trial comparing the Tennant Biomodulator to transcutaneous electrical nerve stimulation and traditional Chinese acupuncture for the treatment of chronic pain in military service members. Mil Med Res 2019; 6:37. [PMID: 31791416 PMCID: PMC6886190 DOI: 10.1186/s40779-019-0227-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The present investigation tested the efficacy of the Tennant Biomodulator, a novel pain management intervention that uses biofeedback-modulated electrical stimulation, to reduce chronic pain and its psychosocial sequelae in a sample of current and former military service members. The Tennant Biomodulator used on its most basic setting was compared to two commonly used, non-pharmacological pain treatments-traditional Chinese acupuncture and transcutaneous electrical nerve stimulation (TENS)-in a comparative efficacy, randomized, open-label trial. METHODS Participants included 100 active duty and retired service men and women with chronic pain undergoing treatment at the Brooke Army Medical Center in Texas, USA, randomly assigned to receive six, weekly sessions of either Tennant Biomodulator treatment, traditional Chinese acupuncture, or TENS, in addition to usual care. Recruitment was conducted between May 2010 to September 2013. Outcome measures were collected at intake, before and after each treatment session, and at a 1-month follow-up. Intent-to-treat analyses were used throughout, with mixed models used to investigate main effects of group, time, and group × time interactions with consideration given to quadratic effects. Outcomes measured included ratings of chronic pain, pain-related functional disability, and symptoms of post-traumatic stress disorder (PTSD) and depression. RESULTS On average, regardless of their treatment group, participants exhibited a 16% reduction in pain measured by the Brooke Army Medical Center's Clinic Pain Log [F(1, 335) = 55.7, P < 0.0001] and an 11% reduction in pain-related disability measured by the Million Visual Analog Scale [MVAS: F(1, 84) = 28.3, P < 0.0001] from baseline to the end of treatment, but no one treatment performed better than the other, and the reductions in pain and pain-related disability were largely lost by 1-month follow-up. Symptoms of PTSD and depression did not change significantly as a function of time or group. CONCLUSIONS Findings build on previous work suggesting that traditional Chinese acupuncture and TENS can reduce pain and its functional sequelae without risks associated with pharmacological pain management. The Tennant Biomodulator used on its most basic setting performs as well as these other interventions. Based on the present findings, large, randomized controlled trials on the Tennant Biomodulator are indicated. Future work should test this device using its full range of settings for pain-related psychological health. TRIAL REGISTRATION Clincialtrials.gov (NCT01752010); registered December 14, 2012.
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Affiliation(s)
- Kimberly S Peacock
- University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Erika Stoerkel
- TLI Foundation, 1750 Tysons Boulevard, McLean, Virginia, 22102, USA
| | - Salvatore Libretto
- Henry M. Jackson Foundation, 6720A Rockledge Drive, Bethesda, MD, 20817, USA
| | - Weimin Zhang
- BD Life Sciences, 1 Becton Drive, Franklin Lakes, NJ, 07417, USA
| | - Alice Inman
- Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA
| | - Michael Schlicher
- Madigan Army Medical Center, 9040A Jackson Ave, Joint Base Lewis-McChord, WA, 98431, USA
| | - John D Cowsar
- MedPost Urgent Care Center, 513 Cibolo Valley Drive, Cibolo, TX, 78108, USA
| | - David Eddie
- Massachusetts General Hospital, Harvard Medical School, 151 Merrimac St. 6th Floor, Boston, MA, 02114, USA.
| | - Joan Walter
- H&S Ventures, Samueli Integrative Health Program, 1800 Diagonal Road, Suite 617, Alexandria, VA, 22314, USA
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Gozani SN. Remote Analgesic Effects Of Conventional Transcutaneous Electrical Nerve Stimulation: A Scientific And Clinical Review With A Focus On Chronic Pain. J Pain Res 2019; 12:3185-3201. [PMID: 31819603 PMCID: PMC6885653 DOI: 10.2147/jpr.s226600] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/02/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) is a safe, noninvasive treatment for chronic pain that can be self-administered. Conventional TENS involves stimulation of peripheral sensory nerves at a strong, non-painful level. Following the original gate-control theory of pain, stimulation is typically near the target pain. As another option, remote stimulation may also be effective and offers potential advantages. OBJECTIVE This narrative review examines mechanisms underlying the remote analgesic effects of conventional TENS and appraises the clinical evidence. METHODS A literature search for English-language articles was performed on PubMed. Keywords included terms related to the location of TENS . Citations from primary references and textbooks were examined for additional articles. RESULTS Over 30 studies reported remote analgesic effects of conventional TENS. The evidence included studies using animal models of pain, experimental pain in humans, and clinical studies in subjects with chronic pain. Three types of remote analgesia were identified: at the contralateral homologous site, at sites distant from stimulation but innervated by overlapping spinal segments, and at unrelated extrasegmental sites. CONCLUSION There is scientific and clinical evidence that conventional TENS has remote analgesic effects. This may occur through modulation of pain processing at the level of the dorsal horn, in brainstem centers mediating descending inhibition, and within the pain matrix. A broadening of perspectives on how conventional TENS produces analgesia may encourage researchers, clinicians, and medical-device manufacturers to develop novel ways of using this safe, cost-effective neuromodulation technique for chronic pain.
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Therapeutic Approaches for Peripheral and Central Neuropathic Pain. Behav Neurol 2019; 2019:8685954. [PMID: 31871494 PMCID: PMC6906810 DOI: 10.1155/2019/8685954] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/20/2019] [Accepted: 10/30/2019] [Indexed: 12/11/2022] Open
Abstract
Neuropathic pain is a chronic secondary pain condition, which is a consequence of peripheral or central nervous (somatosensory) system lesions or diseases. It is a devastating condition, which affects around 7% of the general population. Numerous etiological factors contribute to the development of chronic neuropathic pain. It can originate from the peripheral part of the nervous system such as in the case of trigeminal or postherpetic neuralgia, peripheral nerve injury, painful polyneuropathies, or radiculopathies. Central chronic neuropathic pain can develop as a result of spinal cord or brain injury, stroke, or multiple sclerosis. As first-line pharmacological treatment options, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gabapentinoids are recommended. In trigeminal neuralgia, carbamazepine and oxcarbazepine are the first-choice drugs. In drug-refractory cases, interventional, physical, and psychological therapies are available. This review was structured based on a PubMed search of papers published in the field from 2010 until May 2019.
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A Prospective Six-Month Study of Chronic Pain Sufferers: A Novel OTC Neuromodulation Therapy. Pain Res Manag 2019; 2019:3154194. [PMID: 31687056 PMCID: PMC6800946 DOI: 10.1155/2019/3154194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/07/2019] [Indexed: 02/06/2023]
Abstract
Objective To assess the durability of treatment over various chronic pain conditions of an emerging, nonprescription electromagnetic neuromodulation device that uses pulsed shortwave therapy. Methods A 6-month prospective study, involving 240 chronic pain sufferers, 94% of whom reported using pain pills and 98% reported using pain therapies prior to entering the study. Their average baseline pain was 8.2 VAS points before treatment; they had a pain duration of 6.5 years, and they were positive responders to pulsed shortwave therapy in an initial 7-day trial. Prospective assessments were obtained at intervals of 3, 4, and 6 months following a retrospective 7-day assessment. Longitudinal analyses were conducted to determine pain relief trends after the initial 7-day device use. Results Seven days after initial treatment, the average pain was reduced to 2.9, a 65% pain reduction for the study subjects. At the 6-month measurement, the average pain was 3.3, a 60% pain reduction from baseline. Only 17% of the subjects saw their pain level increase although this new level was still lower than baseline pain. Pain relief translated into improved quality of life and reduced medication use for the majority of the subjects. There were no significant adverse side effects reported over the 6 months of use. Conclusion Ninety-seven percent of the recruited subjects, all of whom had previously reported clinically significant pain relief using the 7-day PSWT device, sustained this relief for 6 months by using the device on an as-needed basis.
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Johnson MI, Jones G, Paley CA, Wittkopf PG. The clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain: a protocol for a meta-analysis of randomised controlled trials (RCTs). BMJ Open 2019; 9:e029999. [PMID: 31662366 PMCID: PMC6830670 DOI: 10.1136/bmjopen-2019-029999] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/05/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The aim of this systematic review with meta-analysis is to evaluate the clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for any type of acute and chronic pain in adults. METHODS AND ANALYSIS We intend to search electronic databases (Cochrane Library, MEDLINE, Embase, CINAHL, PsycINFO, LILACS, PEDRO, Web of Science, AMED and SPORTDiscus) from inception to the present day to identify all randomised controlled trials (RCT) on the use of TENS in adults for any type of pain including acute pain, chronic pain and cancer-related pain. We will screen the RCTs against eligibility criteria for inclusion in our review. Two reviewers will independently undertake RCT selection, data extraction and risk of bias assessment. Primary outcomes will be: (i) participant-reported pain relief of ≥30% expressed as frequency (dichotomous) data; and (ii) participant-reported pain intensity expressed as mean (continuous) data. We will conduct meta-analyses to determine risk ratio for dichotomous data, and mean difference (MD) or standardised MD for continuous data for TENS versus placebo TENS, no treatment or waiting list control, standard of care, and other treatments. Subgroup analyses will include different pain conditions (eg, acute vs chronic), TENS intensity, during versus after TENS, TENS as a sole treatment versus TENS in combination with other treatments and TENS administered as a single dose versus repetitive dose. ETHICS AND DISSEMINATION This systematic review will not use data from individual participants, and the results will be disseminated in a peer-reviewed publication and presented at a conference. PROSPERO REGISTRATION NUMBER CRD42019125054.
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Affiliation(s)
- Mark I Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, West Yorkshire, UK
| | - Gareth Jones
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, West Yorkshire, UK
| | - Carole A Paley
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, West Yorkshire, UK
- Research and Development Department, Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK
| | - Priscilla G Wittkopf
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, West Yorkshire, UK
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GARINIS P, NIKOVA A, BIRBILIS T. [Not Available]. MAEDICA 2019; 14:220-226. [PMID: 31798736 PMCID: PMC6861709 DOI: 10.26574/maedica.2019.14.3.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives:Cervicogenic headache is a chronic cause of pain with a symptomatology varying between neck pain, instability while walking, dizziness, vertigo, ear pain, eye pain, and unilateral tinnitus, which is leading to increased morbidity and use of analgesics. Currently, the contribution of the local infusion of lidocaine in the treatment of cervicogenic headache is very significant. Material and methods:In this pilot study, eight patients with cervicogenic headache were examined between February 2017 and August 2017 and treated with a three-scale method combining: 1) transcutaneous electric nerve stimulation (TENS); 2) minimally invasive methods of lidocaine injections and nerve blocks; and 3) stretching of the cervical and trapezoidal muscles. Results:The results show that the combined three-step therapy decreases both pain intensity based on VAS score and constant use of analgesics. Conclusion:Three-step therapy can be conducted in one session or multiple sessions and appear to constitute a minimally invasive technique that decreases analgesic use, reducing not only their adverse effects and interactions with other pharmaceutics but also the cost of their use.
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Affiliation(s)
- Pavlos GARINIS
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
| | - Alexandrina NIKOVA
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece,Department of Surgical Oncology, Metaxa Cancer Hospital, Piraeus, Greece
| | - Theodossios BIRBILIS
- Department of Neurosurgery, Democritus University of Thrace, Alexandroupolis, Greece
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