Analgesia by low-frequency nerve stimulation mediated by low-threshold afferents in rats

Alternative pain management via endocannabinoids in the time of the opioid epidemic: Peripheral neuromodulation and pharmacological interventions

The use of opioids in pain management is hampered by the emergence of analgesic tolerance, which leads to increased dosing and side effects, both of which have contributed to the opioid epidemic. One promising potential approach to limit opioid analgesic tolerance is activating the endocannabinoid system in the CNS, via activation of CB1 receptors in the descending pain inhibitory pathway. In this review, we first discuss preclinical and clinical evidence revealing the potential of pharmacological activation of CB1 receptors in modulating opioid tolerance, including activation by phytocannabinoids, synthetic CB1 receptor agonists, endocannabinoid degradation enzyme inhibitors, and recently discovered positive allosteric modulators of CB1 receptors. On the other hand, as non-pharmacological pain relief is advocated by the US-NIH to combat the opioid epidemic, we also discuss contributions of peripheral neuromodulation, involving the electrostimulation of peripheral nerves, in addressing chronic pain and opioid tolerance. The involvement of supraspinal endocannabinoid systems in peripheral neuromodulation-induced analgesia is also discussed. LINKED ARTICLES: This article is part of a themed issue on Advances in Opioid Pharmacology at the Time of the Opioid Epidemic. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v180.7/issuetoc.

Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Self-Efficacy and Mood in Elderly with Mild Cognitive Impairment

In previous studies, transcutaneous electrical nerve stimulation (TENS) has been applied to patients with either Alzheimer’s disease (AD) or incipient dementia, resulting in an enhancement in memory and verbal fluency. Moreover, affective behavior was shown to improve. Based on the positive effects of TENS in AD, it was hypothesized that TENS would improve self-efficacy in nondemented elderly with mild cognitive impairment (MCI) who live in a residential home. Four outcome measures, that is, a Dutch translation of the General Self-Efficacy Scale (Algemene Competentie Schaal), the Groninger Activity Restriction Scale, the Philadelphia Geriatric Center Morale Scale, and the Geriatric Depression Scale, were administered. Overall, the results suggest that the experimental group showed a mild improvement in self-efficacy and mood. In contrast, the placebo group showed a considerable reduction in self-efficacy and an increase in depression. Limitations of the present study and suggestions for future research are discussed.

Analgesic effect of electric stimulation of peripheral nerves with different electric frequencies using the formalin test

Although electroacupuncture (EA) has been widely used to treat pain, the optimal frequency of EA therapy remains unclear. The study sought to determine the effect of different EA frequencies in a Sprague-Dawley (SD) rat model of pain. Electric stimulation (ES) at frequencies of 2 Hz, 15 Hz or 100 Hz was applied to the ipsilateral or contralateral sciatic nerve of the injected hindpaw of SD rats. Formalin (50 microl, 5%) was subcutaneously injected into the plantar surface of the left hindpaw to induce a nociceptive response. Behavior, including licking and biting, was observed to have two distinct periods, an early phase during the first 5 mins and a late phase from 21-35 mins after injection. The total biting or licking count served as an Indicator of nociceptive response. Our results indicate that ES of the ipsilateral sciatic nerve at a frequency of 2 Hz or 15 Hz reduced the nociceptive responses in both the early and the late phases of the formalin test, whereas ES at 2 Hz had greater antinociceptive effect than ES at 15 Hz in the early phase. No similar analgesic effect in the early phase was observed for ES at 100 Hz. Both pretreatment with ES at 2 Hz and naloxone (3 mg/kg, s.c.) produced a greater antinociceptive response in the late phase than when ES at 2 Hz was delivered immediately after formalin administration. In addition, ES of the neck muscle or contralateral sciatic nerve at a frequency of 2 Hz also decreased licking and biting activity in both phases. The results of this study indicate that different analgesic mechanisms are involved in the response to ES at frequencies of 2 Hz, 15 Hz and 100 Hz, and that ES at 2 Hz has a greater analgesic effect on formalin-induced nociceptive response, especially when it is delivered prior to the onset of pain. The analgesic effect of ES may be mediated via a central origin in the supraspinal level. These findings suggest that 2 Hz may be a good frequency selection for clinical EA applications in analgesia, and that pretreatment with EA at 2 Hz may be an effective method to treat post-operative pain.

Effects of "isolated" transcutaneous electrical nerve stimulation on memory and affective behavior in patients with probable Alzheimer's disease

BACKGROUND

In previous studies, transcutaneous electrical nerve stimulation (TENS), tactile stimulation, and a combination of the two resulted in cognitive and affective improvements in patients with Alzheimer's disease (AD). As in those studies the therapist was present during the treatment of the experimental and control group (sham stimulation), a positive effect of the combination of TENS with interpersonal communication could not be excluded. Therefore, the effects of "isolated" TENS, i.e., in the absence of the therapist, on memory and affective disturbances in AD patients were examined.

METHODS

Eighteen subjects (78-92 years old) met the NINCDS-ADRDA criteria for the clinical diagnosis of probable AD. To evaluate treatment effects, the experimental group (9) and the control group (9) underwent a number of neuropsychological tests and two observation scales.

RESULTS

Treatment effects were observed for nonverbal short-term (Visual Memory) and long-term (Face Recognition) memory, word fluency (Verbal Fluency), and need of help, whereas patients' affective behavior did not improve.

CONCLUSIONS

The results of the present study show that isolated TENS has a positive effect on patients' cognitive and independent functioning; however, isolated TENS appeared not to have a therapeutic effect on patients' affective behavior.

Sympathetic nerve activity after acupuncture in humans

The aim of the present study was to determine if acupuncture stimulation inhibits sympathetic nerve activity in humans. Multiunit efferent postganglionic sympathetic activity was recorded with a tungsten microelectrode inserted in a muscle fascicle of the peroneal nerve. Mean arterial pressure, heart rate and skin blood flow were also monitored. Pain thresholds were measured by electrical tooth pain stimulation. After a 30 min rest, acupuncture needles were inserted bilaterally into the Li 11 and the Li 4 acupuncture points, and manipulated until 'chi' cramp-like sensation was reported. Electrical stimulation (2 Hz, 0.6-0.8 ms duration, maximal tolerated stimulation without discomfort) was delivered for 30 min and the physiological recordings were continued for 90 min after the end of acupuncture. In a placebo control experiment, the same procedure was followed, except that acupuncture needles were inserted subcutaneously and no manipulation or stimulation was given. The stimulator delivered pulses to an unconnected channel, hence, the same audiovisual stimuli were experienced as with acupuncture, and care was taken to ask the same questions about sensations in the placebo and the acupuncture groups. Electroacupuncture produced an increase in pain threshold which was paralleled by a transient increase in muscle sympathetic nerve activity. During acupuncture, there was a small increase in heart rate and mean arterial pressure, but there was no post-acupuncture hypotension. The placebo control procedure did not change pain threshold or sympathetic nerve traffic. The findings suggest that electroacupuncture produces moderate hypoalgesia in humans paralleled by a significant increase in muscle sympathetic nerve activity.

Effects of short-term transcutaneous electrical nerve stimulation on memory and affective behaviour in patients with probable Alzheimer's disease

The present study investigated whether a 30-minute-a-day transcutaneous electrical nerve stimulation (short-term TENS) might improve disturbances in memory and affective behaviour in patients with probable Alzheimer's disease. The hypothesis was derived from former studies in which beneficial effects on memory and affective behaviour of Alzheimer patients were found after a daily application of 6-h TENS and a 30-min tactile stimulation. The present data reveal that short-term TENS improved some aspects of verbal and visual short-term and long-term memory. Moreover, patients who had undergone this treatment felt, e.g., less dejected, less gloomy, less irritable, more cheerful, more active, and more alert. They were also more interested in social contacts and participated more in daily activities. After a period of 6 weeks following treatment, the effects on memory as well as the improvements in affective behaviour partially remained.

Pain and the placebo in rehabilitation using TENS and laser

The placebo effect of many health-related treatment is generally acknowledged. This paper discusses the role of the placebo in relation to pain perception and pain control. The theoretical basis of the placebo response is examined, followed by a discussion of the factors influencing the placebo response. Finally, the magnitude of the placebo response is explored specifically in relation to outcome measures and the efficacy of transcutaneous electrical nerve stimulation (TENS) and laser for pain relief.

Relations between experimentally induced tooth pain threshold changes, psychometrics and clinical pain relief following TENS. A retrospective study in patients with long-lasting pain

The present study investigates the relationships between clinical pain relief, physiological and psychological parameters. Out of 50 patients with long-lasting musculoskeletal neck- and shoulder-pain treated with transcutaneous electrical nerve stimulation (TENS), 21 were selected and classified as responders (n = 13) or non-responders (n = 8). Tooth pain thresholds (PT) were measured before and after an experimental TENS treatment and the relative change in PT following the stimulation was calculated. Three psychometric self-inventories were administered: Zung Depression Scale, Spielberger's Trait Anxiety Scale and the Multidimensional Health Locus of Control Scale. Responders (R) and non-responders (NR) differed significantly from each other in the PT measurements as well as on the psychometric scales. NR exhibited higher levels of anxiety and depression, a more pronounced powerful other orientation and no change or a decrease in PT following TENS compared to R. These findings indicate relationships and interactions between physiological and psychological factors in patients with long-lasting pain.

The analgesic effect of peripheral nerve stimulation in various tests of nociception in rats

The present study examines analgesic properties of 2 Hz peripheral nerve stimulation in four different tests of nociception: the tail-flick, hot-plate, jump-response and formalin tests. Radial, sciatic and trigeminal nerve stimulation produced decreased response amplitudes to weak electrical foot shocks in the jump-response test. The fact that all three nerves produced the same effect suggests the involvement of general, non-segmental mechanisms. The nerve stimulation produced a characteristic after-effect, lasting several minutes, suggesting the involvement of supraspinal mechanisms. The radial nerve stimulation resulted in the most pronounced reduction in jump responses. Sciatic nerve stimulation also produced analgesia in the formalin test but had no effect on the responsiveness to a brief stimulus at threshold level in the hot-plate or the tail-flick tests. It is concluded that analgesia by peripheral nerve stimulation in animals is most readily detected by tests allowing a quantitative evaluation of responses to above-threshold noxious stimuli and not only measuring reactions occurring at the threshold for nociception.

Analgesia or hyperalgesia following stress correlates with emotional behavior in rats

Analgesia following exposure to a variety of noxious and non-noxious stressors is well documented and is commonly referred to as stress-induced analgesia. Hyperalgesia following stress has also been reported. The present study shows that a mild stressor (15 min of vibration) produced increased tail-flick latencies (TFL) in some rats, but decreased latencies in other rats. The results of the individual subjects were reproduced in a later session: the rats showing increased TFL on day 1, responded with increased TFL on day 2. Rats showing decreased TFL on day 1 responded with decreased TFL on day 2. Whichever reaction occurred, analgesia or hyperalgesia, this correlated with the animal's behavior during the stress procedure. Analgesia was produced in quiet rats and hyperalgesia in hyperemotional ones. Various peripheral nerve stimulation procedures producing hyperemotional reactions also resulted in lowering of the pain threshold. The results of the present study show behavioral modulation of pain mechanisms.