Article

Hypoalgesic Effect of the Transcutaneous Electrical Nerve Stimulation Following Inguinal Herniorrhaphy: A Randomized, Controlled Trial

August 2008
Journal of Pain 9(7):623-9

August 2008
9(7):623-9

DOI:10.1016/j.jpain.2008.01.337

Source
PubMed

Authors:

Josimari Melo DeSantana

Universidade Federal de Sergipe

Valter J Santana-Filho

Universidade Federal de Sergipe

Kathleen Sluka

University of Iowa

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Unlabelled: We investigated the effect of transcutaneous electrical nerve stimulation (TENS) for inguinal herniorrhaphy postoperative pain control in a prospective, randomized, double-blinded, placebo-controlled study. Forty patients undergoing unilateral inguinal herniorrhaphy with an epidural anesthetic technique were randomly allocated to receive either active TENS or placebo TENS. Postoperative pain was evaluated using a standard 10-point numeric rating scale (NRS). Analgesic requirements were also recorded. TENS (100 Hz, strong but comfortable sensory intensity) was applied for 30 minutes through 4 electrodes placed around the incision twice, 2 and 4 hours after surgery. Pain was assessed before and after each application of TENS and 8 and 24 hours after surgery. In the group treated with active TENS, pain intensity was significantly lower 2 hours (P = .028), 4 hours (P = .022), 8 hours (P = .006), and 24 hours (P = .001) after the surgery when compared with the group that received placebo TENS. Active TENS also decreased analgesic requirements in the postoperative period when compared with placebo TENS (P = .001). TENS is thus beneficial for postoperative pain relief after inguinal herniorrhaphy; it has no observable side effects, and the pain-reducing effect continued for at least 24 hours. Consequently, the routine use of TENS after inguinal herniorrhaphy is recommended. Perspective: This study presents the hypoalgesic effect of high-frequency TENS for postoperative pain after inguinal herniorrhaphy. This may reinforce findings from basic science showing an opioid-like effect provided by TENS, given that high-frequency TENS has been shown to activate delta-opioid receptors.

The Effects of Transcutaneous Electrical Nerve Stimulation on Post-Episiotomy Pain Severity in Primiparous Women: A Randomized, Controlled, Placebo Clinical Trial

Article

Full-text available

Aug 2019

Background: Episiotomy or cutting the perineum is the most common operation in obstetrics. Perineal pain is the main complication of episiotomy that affects the quality of life and mental health of the mother. Reducing the pain and side effects of the chemical drugs prescribed for pain relief has attracted the attention of both physicians and scientists. This study was conducted to determine the effects of transcutaneous electrical nerve stimulation (TENS), as an alternative method, on post-episiotomy pain severity. Materials and Methods: This randomized clinical trial was performed on 120 primiparous women who had referred to Sanandaj Besat Hospital in 2018. The patients were divided randomly into three groups, including the intervention group (TENS-On), the placebo group (TENS-Off), and the control group. TENS electrodes were placed near the episiotomy site in genitofemoral and pudendal nerves. The pain was measured after episiotomy in lying, sitting, and activity positions. The pain severity was measured using a pain measurement instrument (numeral rating score) at four-time points, i.e., before the intervention as well as 30, 60, and 120 minutes after the TENS intervention. For data analysis, Pearson correlation, studentâ€™s t-test, Kruskal-Wallis test, ANOVA test, and Mann-Whitney U tests were used. Results: Intragroup evaluation results for placebo and control groups demonstrated no significant difference in the pain score (P>0.05). A significant difference was observed between the mean pain severity of the intervention group and that of the group with walking activities (P=0.04). In terms of the intergroup evaluation, there was a significant difference observed between the mean pain severity of the lying position and that of the control group (P=0.008). Regarding the sitting position, no significant difference was observed between its mean pain severity and that of the other two groups (P=0.04). Conclusion: TENS is an effective and safe method for post-episiotomy pain relief and a routine method used in the obstetrics and gynecology ward. [GMJ.2019;8:e1404]Â

High frequency transcutaneous electrical stimulation in the immediate postoperative period of anterior cruciate ligament reconstruction: a randomized clinical trial

Article

Full-text available

Sep 2022

Introduction: The anterior cruciate ligament (ACL) is an important structure for knee stability. Transcutaneous electrical nerve stimulation (TENS) is an electrical current applied for significant pain relief. Objective: To evaluate the effects of high-frequency TENS on the immediate postoperative period of ACL reconstruction. Methods: 46 patients in the postoperative period of ACL reconstruction were randomly assigned to a control group (CG=23) and a TENS group (TG=23). Knee range of motion (ROM), pain, muscle strength, and drug intake were assessed before surgery and 24 and 48 hours after surgery. The TENS intervention protocol started in the recovery room, shortly after surgery, and was maintained continuously for the first 48 hours after surgery. Results: The TENS group (TG) significantly controlled the increased level of postoperative pain (p<0.05) and significantly increased flexion ROM (p<0.05). When compared to the Control group (CG), the TENS group had a lower intake of ketoprofen (48.27%), diazepam (256.98%), and dipyrone (121.21%), morphine (320.77%), and tramadol (437.46%). Conclusion: Continuous high-frequency TENS significantly reduced pain intensity and significantly improved ROM, muscle strength, and drug intake in the postoperative period of ACL reconstruction.

Transcutaneous Electric Nerve Stimulation Reduces Acute Postoperative Pain and Analgesic Use After Open Inguinal Hernia Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial

Article

Full-text available

Dec 2020
J PAIN

In this randomized, double-blind, placebo-controlled trial, we evaluated the role of transcutaneous electrical nerve stimulation (TENS) in the multimodal treatment (non-opioid analgesics and kinesiotherapy) of postoperative pain following open inguinal hernia repair. In total, 80 males participants with elective primary unilateral hernia Lichtenstein repair were randomly allocated to receive TENS or a placebo-TENS procedure. The TENS group received local and segmental conventional TENS on the first and second postoperative days. In the placebo-TENS group, intensity was set at 0-0.5mA. Change of pain level at rest, when walking, when standing up from bed, pressure algometry parameters and additional analgesic use were the main outcomes. Reduction of VAS pain score and absolute and relative pain relief were observed in the TENS group following the procedures compared to the placebo-TENS group (p<0.001). The pressure pain threshold and maximal tolerable pressure in the hernia side were equal before the TENS procedure in both groups (p=0.84), but after the procedure, these were higher in TENS group (p<0.001). Additional non-opioid analgesics requirements were lower in the TENS group on the first and second postoperative days (p<0.001). TENS is a safe procedure that can reduce postoperative pain and analgesic use after open inguinal hernia repair. The study was registered in the database of clinicaltrials.gov (register number NCT03739060) Perspective This article presents TENS as a safe and effective non-pharmacologic intervention to reduce post-operative pain after open inguinal hernia repair. TENS could be used in daily practice as part of a multimodal postoperative pain treatment, especially for patients suffering from hyperalgesia.

Patient-Administered Transcutaneous Electrical Nerve Stimulation for Postoperative Pain Control After Laparoscopic Cholecystectomy: A Randomized, Sham-Controlled Feasibility Trial

Article

Oct 2020
NEUROMODULATION

Objectives: Transcutaneous electrical nerve stimulation (TENS) is a noninvasive analgesic neurostimulation modality. Difficulties in clinical trial blinding and therapy administration have limited conclusions of previous trials. The aims of this study were to first investigate the feasibility and acceptability of patient-administered TENS after surgery, and second, the feasibility of using sub-sensory TENS as a proxy sham group for patient-blinding. Materials and methods: Over a four-month period, patients undergoing laparoscopic cholecystectomy at a single center were randomized to receive maximally tolerable high-intensity (HI) TENS or sub-sensory low-intensity (LI) TENS. Patients and outcome assessors were blinded. Primary outcomes were the feasibility, tolerability, and acceptability of patient self-administered TENS, measured by patient-reported outcomes, and the strength of patient-blinding, measured using the James Blinding Index (JBI). Secondary outcomes explored clinical recovery and analgesic efficacy. Results: Nineteen patients were screened for inclusion; ten patients were randomized and completed the feasibility study. TENS therapy was variably utilized (median duration of TENS 5.3 hours/day [IQR: 4.1-6.9]). The JBI was 0.7, indicating a strong strength of blinding. Majority of patients found the TENS unit easy to use (90%) and were confident with self-administration (100%). No patients experienced adverse effects of TENS use. Conclusions: Patient-administered TENS is safe and acceptable. Future studies may use sub-sensory TENS as a proxy sham control to more reliably blind patients. A larger, double-blinded RCT employing these techniques is now needed to determine the analgesic efficacy of TENS in an enhanced recovery setting, and its potential to reduce opiate usage.

The Effects of Transcutaneous Electrical Nerve Stimulation on Post-Episiotomy Pain Severity in Primiparous Women: A Randomized, Controlled, Placebo Clinical Trial

Article

Full-text available

Aug 2019

Background: Episiotomy or cutting the perineum is the most common operation in obstetrics. Perineal pain is the main complication of episiotomy that affects the quality of life and mental health of the mother. Reducing the pain and side effects of the chemical drugs prescribed for pain relief has attracted the attention of both physicians and scientists. This study was conducted to determine the effects of transcutaneous electrical nerve stimulation (TENS), as an alternative method, on post-episiotomy pain severity. Materials and methods: This randomized clinical trial was performed on 120 primiparous women who had referred to Sanandaj Besat Hospital in 2018. The patients were divided randomly into three groups, including the intervention group (TENS-On), the placebo group (TENS-Off), and the control group. TENS electrodes were placed near the episiotomy site in genitofemoral and pudendal nerves. The pain was measured after episiotomy in lying, sitting, and activity positions. The pain severity was measured using a pain measurement instrument (numeral rating score) at four-time points, i.e., before the intervention as well as 30, 60, and 120 minutes after the TENS intervention. For data analysis, Pearson correlation, student's t-test, Kruskal-Wallis test, ANOVA test, and Mann-Whitney U tests were used. Results: Intragroup evaluation results for placebo and control groups demonstrated no significant difference in the pain score (P>0.05). A significant difference was observed between the mean pain severity of the intervention group and that of the group with walking activities (P=0.04). In terms of the intergroup evaluation, there was a significant difference observed between the mean pain severity of the lying position and that of the control group (P=0.008). Regarding the sitting position, no significant difference was observed between its mean pain severity and that of the other two groups (P=0.04). Conclusion: TENS is an effective and safe method for post-episiotomy pain relief and a routine method used in the obstetrics and gynecology ward.

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

Article

Jul 2018
PAIN MANAG NURS

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

High-frequency, high-intensity transcutaneous electrical nerve stimulation compared with opioids for pain relief after gynecological surgery: a systematic review and meta-analysis

Article

Full-text available

Oct 2023

Objectives Opioids are important for postoperative analgesia but their use can be associated with numerous side effects. Transcutaneous electrical nerve stimulation (TENS) has been used for acute pain treatment and has dose-dependent analgesic effects, and therefore presents an alternative to intravenous (iv) opioids for postoperative pain relief. The aim of this meta-analysis was to compare high-frequency, high-intensity (HFHI or intense) TENS to iv opioids with regard to postoperative pain intensity, recovery time in the Post Anesthesia Care Unit (PACU) and opioid consumption after elective gynecological surgery. Methods We searched Medline, Embase, Web of Science, Cochrane, Amed and Cinahl for RCTs and quasi-experimental studies (2010–2022), and WHO and ClinicalTrials.gov for ongoing/unpublished studies. Meta-analysis and subsequent Trial Sequential Analysis (TSA) was performed for all stated outcomes. Quality of evidence was assessed according to GRADE. Results Only three RCTs met the inclusion criteria (362 participants). The surgical procedures involved surgical abortion, gynecologic laparoscopy and hysteroscopy. The applied TENS frequency was 80 Hz and intensity 40–60 mA. There was no difference in pain intensity according to Visual Analogue Scale (VAS) at discharge from PACU between the TENS and opioid group (MD VAS −0.15, 95 % CI −0.38 to 0.09) (moderate level of evidence). Time in PACU was significantly shorter in the TENS group (MD −15.2, 95 % −22.75 to −7.67), and this finding was manifested by TSA (high-level of evidence). Opioid consumption in PACU was lower in the TENS group (MD Morphine equivalents per patient mg −3.42, 95 % −4.67 to −2.17) (high-level of evidence). Conclusions There was no detectable difference in postoperative pain relief between HFHI TENS and iv opioids after gynecological surgery. Moreover, HFHI TENS decreases recovery time and opioid consumption in PACU. HFHI TENS may be considered an opioid-sparing alternative for postoperative pain relief after gynecological surgery. Systematic review registration PROSPERO CRD42021231048.

Modulation of torque evoked by wide-pulse, high-frequency neuromuscular electrical stimulation and the potential implications for rehabilitation and training

Article

Full-text available

Mar 2021

The effectiveness of neuromuscular electrical stimulation (NMES) for rehabilitation is proportional to the evoked torque. The progressive increase in torque (extra torque) that may develop in response to low intensity wide-pulse high-frequency (WPHF) NMES holds great promise for rehabilitation as it overcomes the main limitation of NMES, namely discomfort. WPHF NMES extra torque is thought to result from reflexively recruited motor units at the spinal level. However, whether WPHF NMES evoked force can be modulated is unknown. Therefore, we examined the effect of two interventions known to change the state of spinal circuitry in opposite ways on evoked torque and motor unit recruitment by WPHF NMES. The interventions were high-frequency transcutaneous electrical nerve stimulation (TENS) and anodal transcutaneous spinal direct current stimulation (tsDCS). We show that TENS performed before a bout of WPHF NMES results in lower evoked torque (median change in torque time-integral: − 56%) indicating that WPHF NMES-evoked torque might be modulated. In contrast, the anodal tsDCS protocol used had no effect on any measured parameter. Our results demonstrate that WPHF NMES extra torque can be modulated and although the TENS intervention blunted extra torque production, the finding that central contribution to WPHF NMES-evoked torques can be modulated opens new avenues for designing interventions to enhance WPHF NMES.

Transcutaneous electrical nerve stimulation and analgesia following inguinal hernioplasties – Preliminary report

Article

Jan 2019

INTRODUCTION: Inguinal hernioplasty is the most common surgical procedure. Although it is a low-risk surgery, it may present significant postoperative pain. Pharmacological pain relief may result in adverse effects. A double-blind, randomized, prospective, controlled study was conducted to evaluate if transcutaneous electrical nerve stimulation (TENS) analgesia applied during the first 24 h following a Lichtenstein inguinal hernia repair reduces the use of pain relievers in the short-term postoperative period. MATERIALS AND METHODS: A preliminary sample of 24 patients was gathered, according to inclusion and exclusion criteria. Two groups were studied: treatment and control. TENS was applied at a frequency of 100 Hz on the surgical area every 4 h. Both groups received a dose of analgesia during recovery from anesthesia. On-demand intravenous administration of tramadol 50 mg was prescribed during the postoperative period. An electrical muscle stimulator was also placed to the control group, but it was not turned on. Postoperative pain was assessed using the visual analog scale and by the amount and frequency of required pharmacological rescue analgesia. RESULTS: The mean postoperative pain was calculated based on the treatment administered. For the control group, the average was 5.1 (confidence interval [CI]: 3.84–6.35), whereas for the treatment group, it was 0.62 (CI: 0.22–1.01) (P < 0.001). Moreover, requests for rescue analgesia were compared: the TENS-treated group did not ask for rescue analgesia, whereas 57% of the control group requested it (P < 0.001). DISCUSSION: Postoperative analgesia demands a multimodal approach which effectively relieves pain with minimum adverse effects but that is also safe and may be self-administered. Although results are preliminary, in this study we have found a significant difference when using TENS as postoperative analgesia in terms of levels of pain and request for analgesia.

Impact of TENS stimulation on acute postoperative pain after abdominal surgery—a pubmed review

Article

Jun 2023

Transcutaneous electrical nerve stimulation (TENS) is a technique in which pulsed low-voltage electrical currents are delivered through electrodes applied on the intact skin surface of the painful area of the body, by using a special device in order to stimulate peripheral nerves including those for pain relief. This method is used to manage acute and chronic pain, conditions of nociceptive or neuropathic origin. All clinical trials with TENS for postoperative acute pain were included. Case reports, reviews, protocols, letters to the editor, animal experimental research, guidelines, and ongoing or uncompleted trials were excluded. Two hundred fifty-two articles involving postoperative pain and transcutaneous electric nerve stimulation were identified by applying the aforementioned search strategy which resulted in including 18 articles in the analysis. The number of patients assessed for eligibility in each article varies from a maximum of 800 to a minimum of 3. In 88.89% of the articles the frequency of the TENS applied in the patients was mentioned. In half of the research performed in the selected articles pain was evaluated with the visual analogue scale. Immediate postoperative active mobilization of the patient is a key point of shortening the convalescence period and hospitalisation, the one individual in cause being able to attend work and social activities as soon as possible therefore being able to discover non-invasive, simple to use methods that reduce pain overall and the consumption of pharmaceutical analgesics is mandatory. The TENS technique is a non-invasive, safe, complementary technique used in order to reduce acute postoperative pain and improve pulmonary function, especially deep breathing, facilitating active movement and recovery of the patient and significant morbidity reduction.

Transcutaneous electrical acupoint stimulation to reduce opioid consumption in patients undergoing inguinal hernia repair: protocol for a randomized controlled trial

Article

Full-text available

Dec 2022
TRIALS

Background The purpose of this study is to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) in the postoperative treatment of patients undergoing inguinal hernia repair compared with sham and no treatment group. Methods This study is a protocol for a three-armed, single-blinded, placebo-controlled randomized controlled trial. Ninety participants scheduled for inguinal hernia repair will be randomly assigned to the TEAS group ( n = 30), sham group ( n = 30), and control group ( n = 30). The TEAS group will receive treatment using four portable coin-sized electro-stimulators at both local and distal acupuncture points. The sham group will receive sham treatment with mock electrostimulation. The treatment groups will receive mixed frequency stimulation (alternating at 2 and 100 Hz every 3 s) in continuous mode for 30 min at intervals of 2 h for 24 h postoperatively. The control group will receive postoperative pain control using patient-controlled analgesia (PCA) device. The primary outcome is the total morphine dose received in the postoperative period (mg) using PCA 24 h after surgery. The number of PCA demands (i.e., times the button will be pressed) and delivered bolus doses, score on the Visual Analogue Scale, opioid-related side effects, the requirement for supplemental medications, score on the Hospital Anxiety and Depression Scale (HADS), and blood levels of stress hormones cortisol and prolactin. Discussion The results of this trial will determine whether TEAS with intensified stimulation protocol is a safe and effective option for reducing analgesic consumption and postoperative pain. Trial registration ISRCTN76428396. Registered on 05 October 2020. https://www.isrctn.com/ISRCTN76428396

Use of Complementary and Integrative Methods in the Management of Postoperative Pain: A Narrative Literature Review

Article

Full-text available

Aug 2022

Pain is at the top of the common problems experienced by patients in the postoperative period. The use of pharmacological and non-pharmacological methods together is of great importance in the management of postoperative pain. The current multimodal analgesia approach, advances in enhanced recovery after surgery protocols, and the use of safe and low-dose opioids in the management of postoperative pain have made the use of complementary and integrative methods even more important in improving the quality of postoperative pain management. The use of complementary and integrative methods (massage, neuro-linguistic programming, music therapy, laughter therapy, virtual reality distraction, progressive relaxation exercises, hydrotherapy, reiki, reflexology, hot–cold compress, transcutaneous electrical nerve stimulation, acupressure, and aromatherapy) in the management of postoperative pain provides rapid recovery and discharge time, a decrease in the need for analgesics and the frequency and amount of opioid use, and an increase in patient satisfaction, well-being, pain control quality, and quality of life by reducing the patient’s pain. It is important for surgical nurses, who have an important role in postoperative pain management, to know the methods of relieving pain and to include non-pharmacological practices that increase the quality of pain management in the treatment and care process of pain. This article presents the most commonly used complementary and integrative methods in postoperative pain management in light of current information.

Transcutaneous Electric Nerve Stimulation Reduces Pathological Sensation of Mesh One Week after Open Inguinal Hernia Surgery: Follow-Up Results from a Randomized, Double Blind and Placebo-Controlled Trial

Article

Full-text available

May 2022

Background and Objectives: Quality of life (QoL) and chronic pain are important outcomes following hernia surgery. The long-term effects of Transcutaneous Electric Nerve Stimulation (TENS) on postoperative recovery are not well known. In this trial we investigated the role of TENS on QoL and on the incidence of chronic pain following inguinal hernia repair with mesh. Materials and Methods: A total of 80 male patients with elective primary unilateral hernia Lichtenstein repair were randomly allocated to receive TENS or a placebo-TENS procedure. The TENS group received conventional TENS twice a day on the first and second postoperative days. The intensity was set at 0–0.5 mA in the placebo-TENS group. General and hernia-specific QoL, as well as the incidence of chronic pain were assessed using SF-36v2 and the Carolinas comfort scale. Results: Less sensation of mesh was reported by the TENS group patients one week after surgery. At this time point, the mean sensation score was 6.07 ± 8.88 in the TENS group and 14.08 ± 16.67 in the placebo-TENS group (p = 0.029). Although at two days and one week postoperatively, TENS group patients tended to have less pain, less movement restrictions and better overall hernia-specific QoL, the differences were not statistically significant. At 6 months postoperatively, no incidence of chronic pain was found in either the placebo-TENS or TENS group. Conclusions: Conventional TENS applied in the early postoperative period following inguinal hernia repair with mesh was found to reduce mesh-related foreign body sensation one week after surgery. Promising results were also found for other QoL domains.

Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation (TEAS) for Postoperative Pain in Laparoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Article

Full-text available

Jan 2022
EVID-BASED COMPL ALT

Objectives: This meta-analysis aimed to assess the efficacy and safety of transcutaneous acupoint electrical stimulation (TEAS) for postoperative pain in laparoscopy. The review has been registered on the "INPLASY" website and the registration number is INPLASY202150101. Methods: Relevant randomized controlled trials are selected from seven electronic databases (PubMed, the Cochrane Library, Embase, China National Knowledge Infrastructure, Chongqing VIP Information, WanFang Data, and Chinese Biomedical Database) from their inception up to November 30, 2020. Twenty-eight studies were included in this meta-analysis, and the statistical analyses and the exploration of heterogeneity sources were conducted by Stata 15.0 software. Besides, the bias assessment of the included studies was evaluated using the Cochrane risk of bias tool. Results: In total, 28 RCTs covering 2787 participants were included. The meta-analysis suggested that TEAS can effectively relieve pain in the short term after laparoscopy, reduce the postoperative consumption of rescue analgesics, improve the quality of life of patients, and shorten the length of hospitalization. And no serious adverse events are related to TEAS. Therefore, TEAS is relatively safe and efficacy for clinical application. The most used acupoints were Hegu (LI14), Neiguan (PC6), and Zusanli (ST36). Conclusions: TEAS can be recommended as a complementary and alternative therapy for the treatment of postoperative pain after laparoscopy. However, the included RCTs had some methodological limitations. Therefore, larger-size, more rigorous, and higher-quality RCTs are needed in the future to further explore the efficacy and safety of TEAS for postoperative pain after laparoscopy.

Transcutaneous Electrical Acupoint Stimulation Reduces Postoperative Analgesic Requirement in Patients Undergoing Inguinal Hernia Repair: A Randomized, Placebo-Controlled Study

Article

Full-text available

Jan 2021

Given the rising rate of opioid-related adverse drug events during postsurgical pain management, a nonpharmacologic therapy that could decrease analgesic medication requirements would be of immense value. We designed a prospective, placebo-and-randomized controlled trial to assess the clinical effect of transcutaneous acupoint electrical stimulation (TEAS) on the postoperative patient-controlled analgesia (PCA) requirement for morphine, as well as side effects and recovery profile after inguinal hernia repair. Seventy-one subjects undergoing inguinal hernia repair with a standardized anesthetic technique were randomly assigned to one of three analgesic treatment regimens: PCA + TEAS (n = 24); PCA + sham-TEAS (no electrical stimulation) (n = 24), and PCA only (n = 23). The postoperative PCA requirement, pain scores, opioid-related side effects, and blood cortisol levels were recorded. TEAS treatment resulted in a twofold decrease in the analgesic requirement and decreased pain level reported by the patients. In addition, a significant reduction of cortisol level was reported in the TEAS group at 24 h postoperatively compared to the sham and control groups. We conclude that TEAS is a safe and effective option for reducing analgesic consumption and postoperative pain following inguinal hernia repair.

Interventional pain treatment – overview of available procedures

Article

Full-text available

Jan 2019

Chronic pain has become dominant problem in recent years affecting not only patient quality of life but having economic impact and heavy burden on the health systems. The first line in pain management would be patient education, physical rehabilitation and pharmacotherapy. Unfortunately aforementioned treatment often appears incomplete and specialised, targeted pain interventions are warranted. With significant progress in pain medicine, the number of available and effective interventional procedures and techniques have increased. In this manuscript authors have carried out an up to date review of modern interventional techniques with emphasize of anatomy, level of advancement and complexity. Authors classified procedures according to anatomical location: head and neck, spine, upper and lower limb, trunk as well as pathophysiology: interventions in neuropathic pain, cancer pain including neuromodulation techniques. Whenever possible authors relied on evidence based medicine (EBM) but with emphasize of its limitation, especially in assessment of pain relief which remains patient subjective experience. In summary, reimbursement of up to date pain procedures, in the outpatient and hospital setting has been shown. It hopefully guide pain specialists to choose the right intervention and facilitate renumeration within NFZ fee schedule.

Society for translational medicine-expert consensus on the treatment of osteoarthritis

Article

Full-text available

Dec 2019

Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative

Article

May 2018

Higher levels of moderate to vigorous physical activity improve all-cause mortality and cardiovascular events. However, the effect of running, a moderate to vigorous activity, in those with knee osteoarthritis (OA), a common arthritis that occurs with aging, a high-risk group for mortality and cardiovascular events, is unclear. Therefore, we aimed to evaluate the association of self-selected running on OA symptom and structure progression in people with knee OA. This nested cohort study within the Osteoarthritis Initiative (OAI) (2004–2014) included those at least 50 years old with OA in at least one knee. Runners were defined using a self-administered questionnaire at the 96-month visit. At baseline and 48-months, symptoms were assessed and radiographs were scored for Kellgren-Lawrence (KL) grade (2–4) and medial Joint Space Narrowing (JSN) score (0–3). We evaluated the association of self-selected running with outcomes: KL worsening, medial JSN worsening, new knee pain, and improved knee pain over 48 months, adjusting for baseline age, sex, body mass index (BMI), KL score, contralateral KL score, contralateral knee pain, and injury. If data were not available at the 48-month visit, then they were imputed from the 36-month visit. One thousand two hundred three participants had a mean age of 63.2 (7.9) years, BMI of 29.5 (4.6) kg/m², 45.3% male, and 11.5% runners. Data from 8% of participants required imputation. Adjusted odds ratios for KL grade worsening and new frequent knee pain were 0.9 (0.6–1.3) and 0.9 (0.6–1.6) respectively. Adjusted odds ratio for frequent knee pain resolution was 1.7 (1.0–2.8). Among individuals 50 years old and older with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression. Therefore, self-selected running, which is likely influenced by knee symptoms and may result in lower intensity and shorter duration sessions of exercise, need not be discouraged in people with knee OA.

The Effect of Acupuncture on Pain Score after Open Kidney Surgery

Article

Oct 2014

The Evaluation of the Effect of TENS Therapy on Reducing Acute and Chronic Pain Following Varicocelectomy

Article

Full-text available

Jan 2017

Which physiological response triggers the application of the transcutaneous electrical nerve stimulation technique?

Article

Oct 2010

Purpose: To analyze the physiological effects of the application of the transcutaneous electrical nerve stimulation (TENS) technique on patients, to provide guidance for successful implementation in clinical practice. TENS technique involves the application of a pulsed electric current, traditionally used for pain control. Different TENS programming parameters should be adjusted, taking into account that the different programming options will activate various physiological mechanisms. Extensive studies in animals and in healthy subjects have been conducted recently, in order to elucidate the physiological effects produced in the body when TENS is applied. Material and methods: We conducted a comprehensive review of published scientific literature on the use of the TENS technique and its physiological effects. Relevant trials were identified through a search of various databases and reference books on the subject, from the Library of the CEU-Cardenal Herrera University of Valencia. Results: We found 97 references that met the inclusion criteria. Conclusions: TENS produces its analgesic effect by activation of afferents of deep tissues by stimulation of primary Aβ large diameter afferent fibers. The physiological mechanisms of action of TENS at low and high frequency are different, although both occur at peripheral, spinal and supraspinal level, and are based primarily on the activation of different opioid receptors. With the proper combination of parameters, TENS reduces pain from the first minute of application. Regarding the duration of analgesic effect after a treatment session, it is known the importance of using higher intensities for greater duration of post-session effect. The daily repeated application of TENS with the same parameters will lead to the development of tolerance. Although there has been speculation about a vascular effect of the application of TENS, it only has an effect on peripheral circulation when applied at intensity sufficient to achieve significant muscle contractions; in any case the effect is reduced in the area of application. The application of TENS can positively influence muscle activity in patients with motor deficits in stroke and other neurological disorders.

Transcutaneous electrical nerve stimulation for the treatment of acute postoperative pain following spine surgery: a scoping review

Article

Apr 2024
J NEUROSURG-SPINE

OBJECTIVE Given the ubiquity and severity of postoperative pain following spine surgery, developing adequate pain management modalities is critical. Transcutaneous electrical nerve stimulation (TENS) is a promising noninvasive modality that is well studied for managing postoperative pain following a variety of surgeries, but data on using TENS for pain management in the acute postoperative period of spine surgery are limited. Therefore, this review aimed to recapitulate the existing evidence for the use of TENS in postoperative pain management for spine surgery and explore the potential of this modality moving forward. METHODS A scoping review was conducted according to 2020 PRISMA guidelines. Two independently operating reviewers then conducted a systematic search of PubMed, Embase, and Scopus databases to identify studies that reported the use of TENS for the treatment of acute postoperative pain following spine surgery. The following data were abstracted from included studies: study type, sample size, demographics, surgery details, comparison group, assessment parameters, timing of postoperative assessment, TENS technical characteristics, relevant findings, length of hospital stay, complications with TENS, and notable limitations. RESULTS Nine hundred thirty-two publications were screened, resulting in 6 studies included in this review, all of which were prospective clinical trials. The publication dates ranged from 1980 to 2011. Spine surgery types varied; the most common was posterior lumbar interbody fusion. No studies evaluated pain control in cervical- or thoracic-only surgeries. All 6 studies evaluated the level of postoperative pain directly. Five of the 6 studies that directly examined postoperative pain reported lower levels of pharmacological analgesia usage in the TENS groups compared with controls, with 4 of these studies reporting this difference as statistically significant. Length of hospital stay was evaluated in 2 studies, both of which reported decreases in mean length of stay, but these differences were not significant. Notably, every study reported distinct TENS administration parameters while also reporting similar results. CONCLUSIONS This review concludes that TENS is effective at reducing postoperative pain in spine surgery. Further investigation is needed regarding the optimal settings for TENS administration, as well as efficacy in the thoracic and cervical spine.

Efficacy and Safety of Transcutaneous Electrical Nerve Stimulation in Patients Undergoing Inguinal Hernia Repair: A Systematic Review and Meta-analysis

Article

Full-text available

Sep 2023

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.

Investigating the safety and efficacy of nerve stimulation for management of groin pain after surgical herniorrhaphy: a systematic review and meta-analysis

Article

Full-text available

Aug 2023
Hernia

Purpose Chronic post-operative inguinal pain (CPIP) following inguinal hernia repair has been a major sequela affecting 4000–48000 patients annually. Optimal management of CPIP has been a challenge, and pharmacological management particularly with opioids has shown unsatisfactory results. The main objective of this systematic review is to investigate the safety and efficacy of neuromodulation as an alternative intervention for the management of post-operative inguinal pain. Methods A literature search was conducted by three reviewers to identify all relevant studies on the use of neuromodulatory interventions for treating post-operative inguinal pain. Data on study characteristics, neuromodulatory modalities, and patient’s clinical data such as pre/post-interventional pain scores and analgesic requirements were extracted and reported. Results A total of 389 patients with 357 (95.9%) males and 15 (4.1%) females were evaluated. The mean age of study participants was 47.9 ± 10.4 years. There were 187 (48.1%) and 202 (51.9%) patients allocated to the control and trial groups, respectively. The most common neuromodulation modality was TENS (4, 36.4%), followed by SCS (3, 27.3%), PNS (3, 27.3%), and acupuncture-assisted (2, 18.2%). The overall mean follow-up duration of the entire cohort was 3.8 months. The mean difference between pre-operative and post-operative VAS scores in the trial groups was 4.65 (95% Confidence Interval [CI], 2.97, 6.33), which was statistically significant (P value < 0.05). Patient-reported outcome measures showed significant responsiveness toward their treatments. Conclusion Nerve stimulation, in its many forms, is a safe and feasible option for the management of post-operative inguinal pain.

The quality of pain management in adult cancer patients

Conference Paper

Full-text available

Apr 2021

Introduction Cancer patients often suffer from both chronic and acute pain related to their disease [1-3], which may be caused by the disease itself or be the side effect of oncological treatment [4]. Therefore, pain management is an essential part of modern anti-cancer treatment [3]. The level of pain control has an impact on patients’ quality of life [3, 4] and their attitude towards further treatment, such as chemotherapy or radiotherapy [3]. Aim The aim of the study was to assess the quality of pain therapy received by cancer patients, to investigate their satisfaction with pain management and to determine factors affecting their perception of pain related to cancer. Methods An original questionnaire was distributed among 194 patients (63,7±10,8 years, 54% females) treated in two oncological departments of Medical University of Silesia, Katowice, Poland. The questionnaire was anonymous, designed in paper format, and was approved by the chairs of both oncological departments. Each of the patients of the departments at the time of the study was kindly invited to fill out the form. Patients willing to participate returned it to the research team member after finishing the survey. The questionnaire contained a statement on the lack of questions requiring confidential data and both open and closed questions regarding patients' medical history, their perception of pain and its severity in the Numerical Rating Scale (NRS) as well as demographic questions. Statistical analysis was performed using Statistica 13.3 software. Results 39.9% of patients confirmed the feeling of cancer-related pain, without any statistically significant differences in the incidence or severity of pain for gender or tumor location. Most frequently (51.4%), the pain was mild (NRS scores 0-3), but patients reported also moderate (NRS 4-6; 27%) and severe pain (NRS 7-10; 21,6%). Among patients declaring the presence of pain, 81.4% received pain therapy, mostly (95.6%) pharmacotherapy, usually prescribed by oncologist (69.1%), less often by family doctor (14.7%) and palliative care specialist (10.3%). The majority (73.9%) of treated patients agreed that they received optimal care. However, in group of patients receiving pain therapy, 63% declared that they wished to make changes in current pain treatment. 67.9% of patients linked their pain sensation to mood deterioration, more frequently in patients describing their pain as severe (p=0.0001), and moderate and severe pain impaired their daily living more often (p=0.0001). Gender did not affect the perception of pain or mood lowering (p>0.05). Conclusions In our pilot study, patients received therapy for acute and chronic pain, which they declared to be optimal. However, the results suggest that some patients remained undertreated. The perception of cancer-related pain cancer patients may be related to their mood deterioration. References 1. Dalal S, Bruera E. Pain Management for Patients With Advanced Cancer in the Opioid Epidemic Era. American Society of Clinical Oncology Educational Book. 2019;(39):24-35. 2. Brant J, Eaton L, Irwin M. Cancer-Related Pain: Assessment and Management With Putting Evidence Into Practice Interventions. Clinical Journal of Oncology Nursing. 2017;21(3):4-7. 3. Neufeld N, Elnahal S, Alvarez R. Cancer pain: a review of epidemiology, clinical quality and value impact. Future Oncology. 2017;13(9):833-841. 4. Yoon S, Oh J. Neuropathic cancer pain: prevalence, pathophysiology, and management. The Korean Journal of Internal Medicine. 2018;33(6):1058-1069.

Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research

Article

Full-text available

Jun 2022

Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.

Diabetes mellitus as a prognostic factor for a more severe course of COVID-19

Conference Paper

Full-text available

Apr 2021

Introduction: COVID-19 is a disease caused by the SARS-CoV-2 coronavirus, whose dangerous feature is its high transmission rate combined with a higher risk of death. Patients hospitalized with COVID-19 had a mortality risk that was nearly 3.5 times higher than those hospitalized with influenza. In a significant proportion of COVID-19 patients requiring hospitalization, diabetes was a primary risk factor. Aim: The aim of the study is to show that the presence of diabetes in COVID-19 patients is a risk factor for increased mortality among these people. Methods: The analyzed data is based on a systematic review from 2020-2021 on PubMed platform. The following key words were used: type 2 diabetes, COVID-19, SARS-CoV-2, mortality risk. The articles most relevant to the topic of the work were selected. The overall number of reviewed articles was 9. Results: The results of a study in China that was published in BMJ Open Diabetes Res Care showed that patients with severe COVID-19 and diabetes mellitus were significantly more likely to require intensive care unit (ICU) treatment with mechanical ventilation compared to those without diabetes. In Italy the Istituto Superiore di Sanità published a report according to which diabetes was the second most common comorbidity after hypertension in those who died from COVID-19. In 2021, The American Journal of Medicine published the results of a retrospective cohort study that was conducted in Wuhan on a group of 584 COVID-19 patients, in which 84 patients had diabetes comorbidity. It was noted that there were more critically ill patients in the diabetic group, suggesting that this group was more likely to progress to severe disease following SARS-CoV-2 infection. Compared with patients without diabetes, patients with diabetes had higher levels of neutrophils, troponin I, CRP, procalcitonin and D-dimers. The results also showed that people with diabetes were more likely to receive intravenous immunoglobulin and mechanical ventilation. This group also had a higher rate of complications such as respiratory failure and acute heart injury. Looking at the research results, the question arises - how does diabetes contribute to the deterioration of COVID-19. Study published in Cell Metabolism shows that in human monocytes, elevated glucose levels increase SARS-CoV-2 replication, and glycolysis sustains virus replication due to the production of mitochondrial reactive oxygen species. High stress on 69 inflammatory cells can also affect the function of skeletal muscles and the liver, the organs responsible for most of the insulin-mediated glucose uptake. Conclusions: Study results show that diabetes is one of the predictors of more severe course of COVID-19. The course of the disease in this group of patients is characterized by higher values of inflammatory markers and more advanced treatment. In conclusion, patients with COVID-19 and coexisting diabetes require special attention because more often than in non-diabetic patients, severe complications can be observed.

Hyperbaric oxygen therapy in the treatment of diabetic foot syndrome

Conference Paper

Full-text available

Apr 2021

Introduction: Diabetic foot syndrome (DFS) is one of the chronic complications of diabetes mellitus, causing significant morbidity and mortality. Damage to the vascular and nervous systems of the foot affects the blood supply to tissues and metabolic processes, and thus increases their susceptibility to infections and gangrene development. It is estimated that the annual incidence of diabetic foot ulcers (DFU) or necrosis in patients with diabetes is 2-5%. The lifetime risk of developing the condition is 25%. In addition to conventional basic therapy, there are adjuvant therapy methods such as hyperbaric oxygen therapy (HBOT)Aim: The aim of the study is to present the current state of knowledge on the use of hyperbaric oxygen therapy in the treatment of diabetic foot syndrome. Methods: The analyzed data is based on a systematic review from 2011-2021 on the PubMed platform with the following key words combination: (hyperbaric oxygen therapy) AND (diabetic foot). The search criteria were: clinical trial and randomized controlled trial publications. The most appropriate articles regarding the topic of this work have been chosen. The overall number of reviewed articles was 8. Results: Analysed studies assessed the efficacy of adjuvant, systemic HBOT in healing of diabetic foot ulcers and also in the risk of amputation of the affected limb. Wound size reduction in the HBOT groups was greater than in the control groups and in each study varied from 30% to 42.4% versus 18,1% ± 6.5% in the control. The amputation rate was 5% for the HBOT group and 11% for the routine care group. However, Fedorko’s study did not demonstrate an advantage of HBOT combined with wound care compared with wound care alone in reducing indications for amputations. Another randomized controlled trial showed that HBOT, supplemented with either lipoic acid or its R+ enantiomer had a better healing effect than HBOT alone in the treatment of chronic leg wound. Additionally, Irawan’s team study proved that patients with DFU Wagner 3-4 may benefit from this therapy by decreasing HbA1c levels and leukocyte count. Another study showed no significant relationship between HBOT and improved health-related quality of life. However, in the same study HBOT was related to fewer participants reporting mobility problems, pain or discomfort. Conclusions: Diabetic foot syndrome is a major health concern for the growing population of diabetic patients worldwide. The use of HBOT as a form of adjuvant treatment in the combined therapy of the DFU appears as safe and effective method in wound healing. Additionally, this therapy also reduces the risk of amputation of the affected limb and improves the hematological and biochemical conditions by reducing glycemic and inflammatory levels. HBOT plays an important role in the enhancement of wound healing for diabetic foot ulcers.

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

Article

Apr 2021
J MANIP PHYSIOL THER

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

Efficacy and Safety of Transcutaneous Electrical Nerve Stimulation (TENS) for Acute and Chronic Pain: A Systematic Review and Meta-Analysis (Meta-TENS)

Article

Jan 2020

Rehabilitation Variability After Rotator Cuff Repair

Article

Jan 2021
J SHOULDER ELB SURG

Background There has been increasing recognition of the importance for standardized postoperative rehabilitation protocols. Despite published guidelines in 2016 by the American Society of Shoulder and Elbow Therapists (ASSET), optimal postoperative rehabilitation after rotator cuff repair (RCR) remains an area of active academic debate. The goals of this study were 1) to assess the variability of RCR rehabilitation protocols published online, 2) to study the congruence between online RCR rehabilitation protocols and the ASSET consensus statement, and 3) to identify differences in online RCR rehabilitation protocols from before/after 2016. Methods A web-based search was conducted for publicly available RCR rehabilitation protocols from websites of all Accreditation Council for Graduate Medical Education (ACGME) academic orthopedic institutions. A supplemental ten-page Google search was also performed with the search terms “rotator cuff repair rehabilitation protocol”. Collected protocols were grouped by tear size (small/medium or large/massive) and examined for information relating to the following categories: Protocol demographics, adjunctive therapy use, immobilization/range of motion, and strengthening. Findings were compared to the ASSET statement’s recommendations. Protocols published before and after ASSET’s 2016 publication were compared for differences. Results A total of 66 online RCR rehabilitation protocols were collected. Only 16 of 187 (8.5%) ACGME institutions provided online RCR rehabilitation protocols. The collected protocols recommend more aggressive rehabilitation in comparison to ASSET, specifically regarding immobilization time, passive range of motion initiation, active-assisted range of motion initiation, and strengthening initiation (p<0.001). Protocols published after 2016 trended towards more conservative recommendations in comparison to protocols published before 2016. Regardless of this trend, the majority of these recommendations were still largely more aggressive than ASSET’s recommendations. Conclusion Despite an attempt by ASSET to provide standardization, this study highlights the marked variations that still exist regarding RCR rehabilitation. Additionally, online RCR rehabilitation protocols tend to make more aggressive recommendations than the ASSET consensus statement. Further research is needed to address these variations and to either validate, alter, or reject the ASSET recommendations.

Postoperative and Preprosthetic Care

Chapter

Jan 2020

Transcutaneous Electrical Stimulation Influences the Time-Frequency Map of Cortical Activity - A Pilot Study

Conference Paper

Jul 2020

Phantom limb pain (PLP) is pain felt in the missing limb in amputees. Somatosensory input delivered as high-frequency surface electrical stimulation may provoke a significant temporary decrease in PLP. Also, transcutaneous electrical nerve stimulation (TENS) is a somatosensory input that may activate descending inhibitory systems and thereby relieve pain. Our aim was to investigate changes in cortical activity following long-time sensory TENS. Time-frequency features were extracted from EEG signals of Cz and C4 channels (contralateral to the stimulation site) with or without TENS (2 subjects). We found that the TENS caused inhibition of the spectral activity of the somatosensory cortex following TENS, whereas no change was found when no stimulation was applied.Clinical Relevance- Although our preliminary results show a depression of the cortical activity following TENS, a future study with a larger population is needed to provide strong evidence to evaluate the effectiveness of sensory TENS on cortical activity. Our results may be useful for the design of TENS protocols for relief of PLP.

The effects of two different electrical stimulation methods on the pain intensity of the patients who had undergone abdominal surgery with a midline incision: Randomized Controlled Clinical Trial

Article

Jun 2019
CONTEMP NURSE

Aims-Objectives: The purpose of this study is to determine the effects of transcutaneous electrical nerve stimulation (TENS) and transcutaneous acupoint electrical stimulation (TAES) on pain and analgesic drug consumption in patients who had undergone abdominal surgery. Background: Evidence for the effects of and TAES on pain and analgesic consumption on patients undergoing abdominal surgery. Design: This research was conducted as a randomized controlled trial. Methods: This research sample consisted of 48 patients who underwent abdominal surgery with a midline incision. The patients were randomized into three groups, the first intervention group, which used TENS, the second intervention group, which used TAES (ST25, P6, ST36, Lİ4) and the control group, which did not. Results: Pain scores and analgesic consumption of both intervention groups were significantly lower than the control group. Conclusion: The research’s findings reveal that the two electrical stimulation methods have similar effects on pain scores and analgesic consumption in patients.

Factors Influencing Acupuncture Research

Chapter

May 2019

Acupuncture research has been conducted in western countries for more than 50 years, with both positive and negative results being published. Therefore, some researchers question whether acupuncture is just a placebo effect. We believe that acupuncture signal production, process and outcomes are complex and need careful investigation. Many factors may contribute to the failure of a study and result in a wrong conclusion. In this chapter, we aim to analyze the factors that might influence acupuncture research and outcomes. There are mistakes and errors in current acupuncture research in several aspects, including acupuncture methodology, personal ability of acupuncture, study design, data analysis, and selection of participants. We hope that future acupuncture researchers will pay attention to these factors and avoid mistakes and misunderstandings of acupuncture effects.

Head and Neck Cancer Pain

Chapter

Jan 2019

Cancers of the head and neck are a small percentage of malignancies but can be associated with significant pain and deformity. Tumors may present with nociceptive (somatic), neuropathic, or mixed pain symptoms. In addition, treatments including chemotherapy, radiation, and surgery can cause specific pain syndromes. Treatments for head and neck cancer include medical treatments, but interventional pain options have been successfully performed for patients suffering from these pain syndromes. This chapter seeks to outline the various interventional options for patients suffering from pain from head and neck cancer.

Inguinodynia: Nonoperative Management: A Comprehensive Guide to Anatomy and Operative Techniques

Chapter

Jan 2018

Chronic postherniorrhaphy pain is a significant burden on society, and prevention by meticulous hernia repair is essential to reduce this burden. Preoperative identification of patients who are likely to suffer from chronic pain is possible by identifying risk factors. A detailed history and targeted physical examination is required to identify the cause of pain, and diagnostic tests like CT scan or MRI can help rule out treatable causes of pain. Once the diagnosis of chronic postherniorrhaphy pain has been made, a multimodal, multidisciplinary approach to treatment is necessary. Referral to a dedicated pain management facility may be warranted. Identification and treatment of comorbidities is important in the management of all types of chronic pain. Patients should be pharmacologically optimized with antidepressants, antiepileptics, NSAIDs, and topical medications. Patients who have pain in classical nerve distributions should undergo diagnostic and potentially therapeutic nerve blocks. Neuroablation and neuromodulation are promising techniques that may help avoid repeat surgery.

Transcutaneous Electrical Nerve Stimulation Reduces Resting Pain in Head and Neck Cancer Patients: A Randomized and Placebo-Controlled Double-Blind Pilot Study

Article

Apr 2018

Background Individuals receiving radiation for head and neck cancer (HNC) often develop painful oral mucositis that impairs function, possibly leading to feeding tubes, hospitalization, and treatment delays. Although pharmacologic medications provide some relief, many report inadequate analgesia and adverse effects. Transcutaneous electrical nerve stimulation (TENS) is a safe, nonpharmacologic intervention; it decreases pain and analgesics and improves function, yet no studies examined TENS for HNC. Objective The aim of this study was to examine the efficacy of TENS for pain and function in HNC patients. Methods This study used a randomized, double-blinded crossover design; participants received 3 TENS treatments during weeks 4 to 6 of radiation: active, placebo, and no TENS over the temporomandibular joint and upper cervical region. Pain (McGill Pain Questionnaire, visual analog scale [VAS] resting and function), function (mouth opening, tongue movement, speaking), fatigue (VAS), and treatment effectiveness (VAS) were assessed before and after TENS at 3 visits. Results Resting pain (McGill Pain Questionnaire and VAS) decreased significantly more after active TENS than placebo or no TENS; changes in function and pain with function did not differ between conditions. Active TENS decreased fatigue significantly more than no TENS and was rated as more effective than placebo TENS. Conclusion Transcutaneous electrical nerve stimulation improves pain in HNC patients receiving radiation but not function or pain with function relative to placebo or no TENS. Implications for Practice Transcutaneous electrical nerve stimulation may be a viable tool for radiation-induced HNC pain to complement pharmacologic approaches. This nonpharmacologic intervention could decrease the debilitating effects of radiation and analgesics, and improve quality of life. Clinical trials should examine the effects and safety of repeated, daily TENS in HNC patients receiving radiation.

Prolonged reduction in shoulder strength after TENS treatment of exercise-induced acute muscle pain

Article

Mar 2018

Objectives: Transcutaneous electrical nerve stimulation (TENS) is commonly used for reducing musculoskeletal pain to improve function. However, peripheral nerve stimulation using TENS can alter muscle motor output. Few studies examine motor outcomes following TENS in a human pain model. Therefore, this study investigates the influence of TENS sensory stimulation primarily on motor output (strength) and secondarily on pain and disability following exercise-induced delayed-onset muscle soreness (DOMS). Methods: Thirty-six participants were randomized to a TENS treatment, TENS placebo, or control group after completing a standardized DOMS protocol. Measures included shoulder strength, pain, mechanical pain sensitivity, and disability. TENS treatment and TENS placebo groups received 90 minutes of active or sham treatment 24, 48, and 72 hours post-DOMS. All participants were assessed daily. Results: A repeated measures ANOVA and post-hoc analysis indicated compared to the control group, strength remained reduced in TENS treatment (48 hours post-DOMS, p<0.05) and TENS placebo (48 hours post-DOMS, p<0.05; 72 hours post-DOMS, p<0.05) groups. A mixed-linear modeling analysis was conducted to examine the strength (motor) change. Randomization group explained 5.6% of between-subject strength variance (p<0.05). Independent of randomization group, pain explained 8.9% of within-subject strength variance and disability explained 3.3% of between subject-strength variance (both p<0.05). Discussion: While active and placebo TENS resulted in prolonged strength inhibition, the results were non-significant for pain. Results indicated higher pain and higher disability were independently related to decreased strength. Regardless of the impact on pain, TENS, or even the perception of TENS, may act as a nocebo for motor output. This article is protected by copyright. All rights reserved.

Post-Surgical Pain: The Status of Evidence for the Use of Transcutaneous Electrical Nerve Stimulation (TENS)

Article

Jan 2017

Mark I Johnson

Transcutaneous Electrical Nerve Stimulation (TENS) as an Adjunct for Pain Management in Perioperative Settings: A Critical Review

Article

Aug 2017

Mark I Johnson

Introduction: Surgical procedures are ever more complex. Day-case surgical loads are increasing and the length of hospital stays are reducing. Management of pain in perioperative settings remains a challenge. Expert panels recommend a multimodal approach which is often interpreted by medical practitioners as polypharmacy. There is variability in non-pharmacological interventions offered to patients, although transcutaneous electrical nerve stimulation (TENS) has been used since the 1970s. Recommendations from expert panels are inconsistent about the use of TENS in perioperative pain settings. Areas covered: This critical review outlines the challenges of managing pain in perioperative settings and uses a narrative synthesis to evaluate the findings of systematic reviews on the clinical efficacy of TENS for pain in perioperative settings. Expert commentary: Moderate evidence from systematic reviews suggests that TENS is superior to placebo (no current) TENS for reducing analgesic consumption and improving pain, pulmonary function, and nausea and vomiting. Therefore, it seems reasonable to offer TENS as an adjunct to core treatment for surgical pain, especially because it is inexpensive and has a favorable safety profile compared with long-term medication. Practical considerations for the integration of TENS into service delivery are discussed.

Effect of Transcutaneous Electric Nerve Stimulation on Pain after Total Knee Arthroplasty: A Blind Randomized Controlled Trial

Article

May 2017

Transcutaneous electric nerve stimulation (TENS) has proven to be effective for postsurgical pain relief. However, there is a lack of well-constructed clinical trials investigating the effect of TENS after total knee arthroplasty (TKA). In addition, previous investigations reported that low- and high-frequency TENSs produced analgesic tolerance after 4 or 5 days of treatment. The aim of this study is to explore the effect of burst TENS on pain during hospitalization after TKA and to investigate whether burst TENS produces analgesic tolerance after 4 or 5 days of treatment. This stratified, triple blind, randomized controlled trial was approved by the University Hospital Brussels. Sixty-eight subjects were screened for eligibility before surgery; 54 were found eligible and 53 were included in the analyses. Patients were allocated to either a burst TENS or sham burst TENS group. TENS was applied daily during continuous passive mobilization. Knee pain intensity, knee range of motion, and analgesic consumption were assessed daily. Patients received burst TENS (N = 25) or sham burst TENS (N = 28). No significant differences in knee pain intensity were found between the groups (p > 0.05). Within the TENS and the sham TENS groups, the difference in knee pain before and after treatment did not evolve over time (p > 0.05). This study found no effects of burst TENS compared with sham burst TENS on pain during hospitalization after TKA.

Basic Understanding of Transcutaneous Electrical Nerve Stimulation

Article

Dec 2016

Transcutaneous electrical nerve stimulation (TENS) is one of the representative physiotherapical modalities used for the treatment of various musculoskeletal disorders by the application of electrical stimuli. In dental practice, it has long been used in the treatment of acute and chronic orofacial pain conditions including temporomandibular disorders. TENS is the delivery of therapeutic electrical stimuli with a variety of electrical intensity, frequency and duration to stimulate peripheral nerve through surface electrodes with various form and placement. While controversy still remains over the clinical effectiveness and application of TENS, basic understanding of its electrical properties and the expected biological reactions is important to increase the therapeutic effect and decrease the risk of possible side effects. This review, therefore, focuses on basic understanding of TENS including its underlying mechanisms and stimulation parameters.

Ilioinguinal and Genitofemoral Neuralgia

Chapter

Apr 2017

Fatimah Habib

Genitofemoral and ilioinguinal neuralgia are common causes of pelvic pain and should be included in the differential for inguinodynia (groin pain), especially in patients with risk factors such as recent pelvic or abdominal surgery, poorly controlled diabetes, or obesity. Different neuralgias are characterized by a different and somewhat specific distribution of pain; however, there are considerable variations in the course of both nerves which can result in changes in the distribution of innervation and thus changes in the distribution of pain (Cesmebasi et al. Clin Anat 28:128–135, 2015; Rab et al. Plast Reconstr Surg 108(6):1618–1623, 2001). Genitofemoral, ilioinguinal, and iliohypogastric nerves are known as border nerves, since they supply sensory innervation at the border of the abdomen and the thigh region (Peng and Tumber Pain Phys 11:214–224, 2008). Injury to these nerves results in pain and paresthesias in the groin region, which due to the proximity and anatomic variability of the course of the nerves makes it difficult to tease apart the truly injured nerve (Acar et al. Turk Neurosurg 23(6):753–757, 2013; Amid et al. J Am Coll Surg 213:531–536, 2011; Cesmebasi et al. Clin Anat 28:128–135, 2015; Rab et al. Plast Reconstr Surg 108(6):1618–1623, 2001). Also due to the proximity and similar course, these nerves are at risk for injury from the same types of surgeries or traumas. All three originate from the lumbar plexus, making the diagnosis quite challenging. The appropriate treatment plan relies on an accurate diagnosis. Different modalities for treatment exist, many of which are still being investigated.

针灸不是心理作用 -西方针刺研究中的缺陷和错误

Article

Aug 2016

Martin Wang

目前，有些西方针灸研究认为针刺疗效不过是心理暗示作用。心理暗示作用的前提是受暗示者（病人）有清醒的意识,能对暗示作出反应和相信暗示。中国的针灸研究和临床工作者早就发表过许多文章证明针刺能治疗昏迷，休克，植物人状态，麻醉后复苏延迟等临床状态，这种状态下病人根本就没有对外界暗示行为的辨识能力，或者这种辨识能力极其微弱，不足以产生对病人的暗示作用。而西方针灸研究者几乎没有研究过针刺对于这些特殊临床状态的治疗作用。通过对比西方国家和中国在针刺研究中的异同，我们认为导致西方针刺研究失败的主要原因是针刺组疗效不高，其最主要原因是治疗频次低和治疗总次数低,而不是来自于虚拟对照组的应用方面。我们发现西方针灸多为每周1-2次，共10次左右（我们称之为西方式针刺），而中国针刺多为每周5-6次，总次数超过12次（多为15-30次）（可称之为中国式针刺）。中国针刺的第一疗程平均每天刺激量和总疗程刺激量皆比西方研究高，前者为0.80比0.25，后者为18.0比2.4。高频次治疗时，针刺组疗效多在45%以上，远比西方目前报告的对于同类疾病的疗效高。临床研究中的心理暗示作用大小变异非常大，影响因素也极多。但是，刺入性和非刺入性虚拟针刺组之间的差别却并不大。高频次治疗时，虚拟对照组疗效并不随治疗频次增加而增加，多在23%左右，故而针刺组和虚拟针刺组之间的差别非常显著。这个现象也明显表现在用TENS 或激光治疗中。 .......

Factors influencing Acupuncture Research

Article

Dec 2016

Martin Wang

Abstract: Acupuncture research has been continued in the western countries for more than 50 years, while there are still positive and negative results published. Some researchers question whether acupuncture is just a placebo effect. We believe that acupuncture research is much more complex than that of western medicine. Many factors could contribute to the failure of a study to result in a wrong conclusion. In this chapter, we aimed to analyze the factors that might influence acupuncture research. It has been found that there are mistakes and errors in current acupuncture researches in the following aspects: acupuncture methodology, personal ability of acupuncture, study design, data analysis, and selection of participants. We hope that future acupuncture researchers could pay attention to these factors and avoid future mistake and wrong understanding of acupuncture effect.

Placebo effect, sham acupuncture and acupuncture research

Article

Full-text available

Dec 2016

Martin Wang

The involvement of sham acupuncture group made lots of acupuncture trials fail to show specific healing effect of acupuncture as a therapy. We have analyzed the research data on acupuncture that were performed both in the Western countries and in China and found that the trails in the Western countries were mostly done as once or twice per week for totally about 10 sessions (Western style); while that in China were mostly five or six sessions per week for more than 12 sessions (Chinese style). With the Western style of acupuncture, the results are largely variable: some trails support the specific healing effect of acupuncture, some not; while with the Chinese style of acupuncture, almost all published data support the acupuncture. This paper pays more attention to the influence of sham acupuncture in acupuncture studies. Current data showed that placebo effect is largely affected by a lot of factors, from the person's susceptibility, body health condition, nature of disease, the way of hint, to the behavior of the person who applies the hint. Therefore, the placebo effect, as reflected in sham groups of study, is largely variable from trail to trail. However, we found that the placebo effect from inserted sham acupuncture and non-inserted sham acupuncture group is very similar in size; no matter this is tested in a given trial, or as an average of various trails. Also, the size of placebo effect of sham group is largely variable with the Western style of acupuncture but pretty stable and remained at low level with the Chinese style of acupuncture. This phenomenon can also be seen with transcutaneous electrical nerve stimulation (TENS) or laser treatment. Therefore, we recommend for future acupuncture study, to eliminate the influence of placebo effect, the inserted acupuncture sham group can be used, so as to eliminate the blinding procedure; and adapt the Chinese high treatment frequency and high total treatment sessions. During the study course, pay attention to the placebo effect curve during the Chinese style of acupuncture, to find the possible platform phase and reduction phase of a placebo effect. We predict that, though initially the healing effect of the sham and verum acupuncture groups might be similar, but after sometimes of treatment sessions, they would be separated with the acupuncture group showing sustained healing effect while the sham acupuncture group, remaining at low level or reversing to pre-treatment status. Abstract: Introduction:

'Acupuncture is a placebo'? Are you kidding? -Errors and mistakes in acupuncture researches in Western countries (I)

Article

Nov 2016

Currently, some researchers stated that acupuncture is merely a placebo effect. Theoretically, a placebo effect needs a person (patient) to be clear in mind being able to react to the emotional or actual hint, and to response to believe the hint. A large number of acupuncture studies from China reported that acupuncture can work on clinic conditions, in which the patient is with almost no, or very weak consciousness, such as coma, shock, dementia, persistent vegetative state. These data strongly support that acupuncture can work by itself without need to depend on a placebo effect. Unfortunately, it is very rare in the Western countries to have acupuncture trial on these clinic conditions.

Analgesia in the surgical intensive care unit

Article

Oct 2016
POSTGRAD MED J

Critically ill patients are a heterogeneous group with diverse comorbidities and physiological derangements. The management of pain in the critically ill population is emerging as a standard of care in the intensive care unit (ICU). Pain control of critically ill patients in the ICU presents numerous challenges to intensivists. Inconsistencies in pain assessment, analgesic prescription and variation in monitoring sedation and analgesia result in suboptimal pain management. Inadequate pain control can have deleterious effects on several organ systems in critically ill patients. Therefore, it becomes incumbent on physicians and nurses caring for these patients to carefully evaluate their practice on pain management and adopt an optimal pain management strategy that includes a reduction in noxious stimuli, adequate analgesia and promoting education regarding sedation and analgesia to the ICU staff. Mechanistic approaches and multimodal analgesic techniques have been clearly demonstrated to be the most effective pain management strategy to improve outcomes. For example, recent evidence suggests that the use of short acting analgesics and analgesic adjuncts for sedation is superior to hypnotic based sedation in intubated patients. This review will address analgesia in the ICU, including opioid therapy, adjuncts, regional anaesthesia and non-pharmacological options that can provide a multimodal approach to treating pain.

Postoperative and Preprosthetic Care

Chapter

Jan 2013

Michelle M. Lusardi

Pain assessment in cognitively impaired and unimpaired older adults: A comparison of four scales

Article

Full-text available

Jun 2001

The purpose of the study was to compare the psychometric properties of four established pain scales in a population of hospitalized older adults (mean age, 76 years) with varying levels of cognitive impairment. Patients made ratings of current pain three times/day for 7 days. They also made retrospective daily, weekly, and bi-weekly ratings of usual, worst, and least pain levels over a 14-day period. Ratings were made on four different scales, varying in numeric and verbal demands: a five-point verbal rating scale, a seven-point faces pain scale, a horizontal 21-point (0-100) box scale, and two vertical 21-point (0-20) box scales (measuring pain intensity and pain unpleasantness). The accuracy, reliability, construct validity, postdictive validity, and bias susceptibility of each scale were evaluated. The horizontal 21-point box scale emerged as the best scale with respect to both psychometrics and validity, regardless of mental status. Pain intensity did not vary as a function of mental status. Retrospective estimates of pain varied by mental status: a combination of usual/worst pain was best for cognitively impaired patients, while a combination of usual/least pain was best for unimpaired patients. These findings support the use of the 21-point box scale for pain assessment in older patients, including those with mild-to-moderate cognitive impairment. They also support the ability of older, cognitively impaired patients to rate pain reliably and validly.

Stimulation of Deep Somatic Tissue with Capsaicin Produces Long-Lasting Mechanical Allodynia and Heat Hypoalgesia that Depends on Early Activation of the cAMP Pathway

Article

Full-text available

Aug 2002
J NEUROSCI

Kathleen Sluka

Pain and hyperalgesia from deep somatic tissue (i.e., muscle and joint) are processed differently from that from skin. This study examined differences between deep and cutaneous tissue allodynia and the role of cAMP in associated behavioral changes. Capsaicin was injected into the plantar aspect of the skin, plantar muscles of the paw, or ankle joint, and responses to mechanical and heat stimuli were assessed until allodynia resolved. Capsaicin injected into skin resulted in a secondary mechanical allodynia and heat hypoalgesia lasting approximately 3 hr. In contrast, capsaicin injection into muscle or joint resulted in a long-lasting bilateral (1-4 weeks) mechanical allodynia with a simultaneous unilateral heat hypoalgesia. The pattern and degree of inflammation were similar when capsaicin was injected into skin, muscle, or joint, with peak increases 24 hr after injection. Heat hypoalgesia that occurs after injection into deep tissue was reversed by spinal blockade of adenylate cyclase or protein kinase A (PKA). Interestingly, mechanical allodynia was reversed if adenylate cyclase or PKA inhibitors were administered spinally 24 hr, but not 1 week, after injection of capsaicin. Spinally administered 8-bromo-cAMP resulted in a similar pattern, with heat hypoalgesia and mechanical allodynia occurring simultaneously. Thus, injection of capsaicin into deep tissues results in a longer-lasting mechanical allodynia and heat hypoalgesia compared with injection of capsaicin into skin. The mechanical allodynia depends on early activation of the cAMP pathway during the first 24 hr but is independent of the cAMP pathway by 1 week after injection of capsaicin.

Efficacy of Percutaneous Electrical Nerve Stimulation for the Treatment of Chronic Low Back Pain in Older Adults

Article

Full-text available

Jun 2003

To determine the efficacy of a complementary analgesic modality, percutaneous electrical nerve stimulation (PENS), for the treatment of chronic low back pain (CLBP) in community-dwelling older adults. Randomized, controlled clinical trial. University of Pittsburgh Pain Evaluation and Treatment Institute. Thirty-four English speaking, community-dwelling adults aged 65 and older with CLBP of at least moderate intensity experienced every day or almost every day. Subjects were randomized to receive twice-weekly PENS and physical therapy (PT) or sham PENS and physical therapy for 6 weeks. At baseline, immediately after the 6-week intervention period, and 3 months later, the primary outcome measures pain intensity and pain-related disability were assessed. The secondary outcome measures physical performance (timed chair rise, functional reach, gait speed, static and isoinertial lifting), psychosocial factors (mood, sleep, and life control), and cognitive function (measures of attention, concentration, and mental flexibility) were also collected. Subjects randomized to PENS plus PT displayed significant reductions in pain intensity measures from pre- to posttreatment (P <.001), but the sham PENS plus PT group did not (P =.94). These pain reduction effects were maintained at 3-month follow-up. Similarly, significant reductions in pain-related disability were observed at posttreatment (P =.002) for the PENS plus PT group and were maintained at follow-up, but the sham PENS plus PT group did not show reductions in pain-related disability (P =.81). Of the secondary outcome measures, psychosocial function, timed chair rise, and isoinertial lifting endurance also improved significantly at posttreatment for the PENS plus PT group, and their improvement was sustained at 3-month follow-up, but the sham PENS plus PT did not display significant changes on these measures after treatment. This preliminary study suggests that PENS may be a promising treatment modality for community-dwelling older adults with CLBP, as demonstrated by reduction in pain intensity and self-reported disability, and improvement in mood, life control, and physical performance. Larger studies with longer duration of follow-up are needed to validate these findings and support the use of PENS in clinical practice.

Spinal 5-HT(2) and 5-HT(3) receptors mediate low, but not high, frequency TENS-induced antihyperalgesia in rats

Article

Full-text available

Oct 2003

Transcutaneous electrical nerve stimulation (TENS) is a form of non-pharmacological treatment for pain. Involvement of descending inhibitory systems is implicated in TENS-induced analgesia. In the present study, the roles of spinal 5-HT and alpha(2)-adrenoceptors in TENS analgesia were investigated in rats. Hyperalgesia was induced by inflaming the knee joint with 3% kaolin-carrageenan mixture and assessed by measuring paw withdrawal latency (PWL) to heat before and 4 h after injection. The (1). alpha(2)-adrenergic antagonist yohimbine (30 microg), (2). 5-HT antagonist methysergide (5-HT(1). and 5-HT(2). 30 microg), one of the 5-HT receptor subtype antagonists, (3). NAN-190 (5-HT(1A), 15 microg), (4). ketanserin (5-HT(2A), 30 microg), (5). MDL-72222 (5-HT(3), 12 microg), or (6). vehicle was administered intrathecally prior to TENS treatment. Low (4 Hz) or high (100 Hz) frequency TENS at sensory intensity was then applied to the inflamed knee for 20 min and PWL was determined. Selectivity of the antagonists used was confirmed using respective agonists administered intrathecally. Yohimbine had no effect on the antihyperalgesia produced by low or high frequency TENS. Methysergide and MDL-72222 prevented the antihyperalgesia produced by low, but not high, frequency TENS. Ketanserin attenuated the antihyperalgesic effects of low frequency TENS whereas NAN-190 had no effect. The results from the present study show that spinal 5-HT receptors mediate low, but not high, frequency TENS-induced antihyperalgesia through activation of 5-HT(2A) and 5-HT(3) receptors in rats. Furthermore, spinal noradrenergic receptors are not involved in either low or high frequency TENS antihyperalgesia.

Pain reducing effect of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: A randomized crossover trial

Article

Full-text available

Apr 2004

Transcutaneous electrical nerve stimulation (TENS) is a frequently applied therapy in chronic pain although evidence for effectiveness is inconclusive. Several types of TENS, based on different combinations of frequency, pulse duration and intensity, exist. The precise mechanism of action and the relevance of combinations of stimulus parameters are still unclear. To compare the effectiveness of three types of TENS we conducted a randomized, single blinded crossover trial. Patients received two times a 2-week period of daily TENS treatment, separated by a washout period of 2 weeks. In total, 180 chronic pain patients were randomized into three groups. In group 1, high frequency, low intensity TENS (HFT) was compared with high frequency, high intensity TENS (HIT). In groups 2 and 3, HFT and HIT were compared with a control TENS (COT). The order of applying the different modalities of TENS in each group was also randomized. Primary outcome was the patient's overall assessment of effectiveness and pain reduction (VAS). No differences were found in patient's assessment or pain reducing effect between the three groups, indicating no superiority of one type of TENS. In total, 56% continued TENS after the 2-week treatment period. At 6 months, 42% of all patients still used TENS. We concluded that there were no differences in effectiveness for the three types of TENS used in this study. Because no placebo group was included, no definite conclusions on effectiveness of TENS in general in the treatment of chronic pain could be made.

Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life

Article

Full-text available

Jun 2004

To evaluate the effect of percutaneous neuromuscular electrical stimulation (P-NMES) of the shoulder muscles on shoulder pain intensity and health-related quality of life in chronic hemiplegia. Prospective, open label design. The outpatient services of a large teaching rehabilitation hospital in The Netherlands. Fifteen stroke survivors with chronic (> six months) hemiplegia and a therapy-resistant painful shoulder with subluxation. All patients suffered from clinically relevant shoulder pain, as assessed by a score of at least 4 out of 10 on a numerical rating scale. Shoulder subluxation was indicated by at least 1/2 fingerbreadth of glenohumeral separation on palpation. Six hours of P-NMES per day for a total of six weeks. Shoulder pain (Brief Pain Inventory), shoulder subluxation (clinical and radiographic), shoulder pain-free external rotation (hand-held goniometer), motor impairment (Fugl-Meyer Motor test) and quality of life (SF-36) were assessed before treatment, after six weeks of intramuscular stimulation, at three months and six months follow-up. A significant reduction in pain was found on the Brief Pain Inventory. Pain reduction was still present at six months follow-up. All domains, in particular bodily pain, of the SF-36 showed improvement in the short term. After six months of follow-up, bodily pain was still strongly and significantly reduced, whereas social functioning and role physical demonstrated a nonsignificant improvement of more than 10% compared with baseline. This pilot suggests that P-NMES potentially reduces shoulder pain in chronic hemiplegia. To establish the clinical value of P-NMES in treating hemiplegic shoulder pain a randomized controlled trial is needed.

Effect of the Intensity of Transcutaneous Acupoint Electrical Stimulation on the Postoperative Analgesic Requirement

Article

Oct 1998
Surv Anesthesiol

Clinical pharmacology of opioids in the treatment of pain

Article

G.K. Gourlay

EMG-assisted relaxation training in the management of chronic low back pain

Article

Jan 1981

This study examines the short and long-term effects of EMG-assisted relaxation training in a series of 18 chronic low back pain patients. All patients had a minimum of six laboratory training sessions and were asked to practice on their own what they were learning in the laboratory. The results indicated that patients showed significant decreases in EMG activity within and across sessions as a function of training. Significant decreases in subjective ratings of tension were obtained within and across training sessions and there was a significant drop in daily ratings of tension taken outside of the lab environment over the course of treatment. The patients also showed a significant decrease in levels of pain within each training session. While there was a tendency for daily pain ratings to decrease over the course of treatment, this did not reach statistical significance. However, by the end of the first six laboratory sessions, 15 out of 18 patients reported experiencing regular decreases in pain while practicing their relaxation skills outside of the lab. At one year follow-up, 9 out of 13 patients responding had maintained initial therapeutic gains.

The Effect of Location of Transcutaneous Electrical Nerve Stimulation on Postoperative Opioid Analgesic Requirement

Article

Nov 1998
ANESTH ANALG

Transcutaneous electrical nerve stimulation (TENS) has been used as a complementary (supplemental) therapy to opioid analgesics for pain relief after surgery.Simultaneous stimulation at a classical Chinese acupoint site and periincisional dermatomes significantly decreases the postoperative analgesic requirement. This sham-controlled study was designed to assess the relative effectiveness of acupoint versus nonacupoint stimulation on the postoperative hydromorphone (HM) requirement, the incidence of opioid-related side effects, and the overall recovery profile. One hundred women undergoing total abdominal hysterectomy or myomectomy procedures with a standardized general anesthesia were randomly assigned to one of four postoperative analgesic treatment regimens (n = 25 each): Group I = sham-TENS (no electrical current) at the Zusanli (ST36) acupoints, Group II = nonacupoint-TENS at the shoulders, Group III = dermatomal-TENS at the level of the surgical incision, and Group IV = acupoint-TENS at the Zusanli acupoints. The frequency of TENS was set in the standard dense-and-disperse mode of 2/100 Hz. The intensity of stimulation was set at 0 mA for patients in Group I and at 9-12 mA for patients in Groups II, III, and IV. A patient-controlled analgesia (PCA) device programmed to deliver bolus doses of HM 0.2-0.4 mg IV on demand with a minimal lockout interval of 10 min was used to quantify the postoperative opioid analgesic requirement. Standard 100-mm visual analog scales were used to assess pain, as well as sedation, fatigue, and nausea, at specific intervals after surgery. The numbers of PCA demands and delivered bolus doses, requirements for supplemental medication, and any opioid-related side effects were recorded. In the first 24 h postoperatively, the opioid requirements in Groups III and IV were decreased by 37% and 39%, respectively, compared with the control (sham) group and 35% and 38%, respectively, compared with Group II. The duration of PCA usage and the incidences of nausea and dizziness were also significantly decreased in Groups III and IV compared with Groups I and II. We conclude that periincisional dermatomal and Zusanli acupoint stimulation were equally effective in decreasing the postoperative opioid analgesic requirement and in reducing opioid-related side effects. Both of these positions were more effective than the nonacupoint (shoulder) location. Implications: The location of the stimulating electrodes seems to be an important determinant of the efficacy of transcutaneous electrical nerve stimulation in decreasing the need for opioid analgesics in the postoperative period. This study demonstrates that transcutaneous electrical nerve stimulation applied at the dermatomal level of the skin incision is as effective as Zusanli acupoint stimulation, and both were more effective than stimulation at a nonacupoint (shoulder) location. (Anesth Analg 1998;87:1129-34)

Effect of the Intensity of Transcutaneous Acupoint Electrical Stimulation on the Postoperative Analgesic Requirement

Article

Aug 1997
ANESTH ANALG

The Effect of Stimulus Frequency on the Analgesic Response to Percutaneous Electrical Nerve Stimulation in Patients with Chronic Low Back Pain

Article

Apr 1999
ANESTH ANALG

EFFECT OF ELECTRICAL STIMULATION ON THE POSTOPERATIVE OPIOID ANALGESIC REQUIREMENT: ACUPOINT VERSUS NON-ACUPOINT STIMULATION

Article

Sep 1998
ANESTHESIOLOGY

EMG-assisted relaxation training in the management of chronic low back pain.

Article

Jan 1981

Francis J Keefe

Examined the short- and long-term effects of EMG-assisted relaxation training in 18 chronic low back pain patients (mean age 37.2 yrs). All Ss had a minimum of 6 laboratory training sessions and were asked to practice on their own what they were learning in the laboratory. Results indicate that Ss showed significant decreases in EMG activity within and across sessions. There was a significant drop in daily ratings of tension taken outside of the lab environment over the course of treatment. Ss also showed a significant decrease in levels of pain within each training session. At 1-yr follow up, 9 of 13 Ss responding had maintained initial therapeutic gains. (22 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Effect of transcutaneous electrical nerve stimulation for pain relief on patients undergoing hemorrhoidectomy

Article

Feb 1999

Posthemorrhoidectomy pain control remains a challenging problem. Transcutaneous electrical nerve stimulation is known to be effective in the treatment of many diseases. Our aim was to investigate the effect of transcutaneous electrical nerve stimulation on pain relief in patients undergoing hemorrhoidectomy. Sixty patients with symptomatic hemorrhoids were randomly allocated into two groups, the acupoint group (n = 30) and the nonpoint control group (n = 30). Transcutaneous electrical nerve stimulation was applied to those patients who received hemorrhoidectomy, and patient-controlled analgesia was achieved by injection of morphine through ambulatory infusion pumps. The dependent measures in this study were pain score from 0 (no pain) to 10 (agonizing pain), analgesic doses administrated through patient-controlled analgesia, and postoperative complications. The subjective pain scores evaluated 8, 12, 16, and 24 hours after hemorrhoidectomy in the control group and the acupoint group were 5.9 +/- 0.5 and 4.1 +/- 0.5, 5.7 +/- 0.5 and 3.5 +/- 0.4, 4.1 +/- 0.4 and 2.3 +/- 0.3, and 3.2 +/- 0.4 and 1.9 +/- 0.2, respectively (two-way analysis of variance; P < 0.05). There was a significant difference between treatment groups in morphine use, with 11.6 +/- 2.2 mg in the control group and 6.2 +/- 1.3 mg in the acupoint group (P < 0.05). The acupoint group tended to have less postoperative acute urinary retention (Fisher's exact probability test; P = 0.145) and less need for analgesics than the control group (P = 0.112, Fisher's exact test). Transcutaneous electrical nerve stimulation is effective for pain relief in patients receiving hemorrhoidectomy. Its efficacy and safety could assist outpatient pain management after hemorrhoidectomy.

Studies with pain rating scales

Article

Sep 1978

Good correlation has been shown between pain scores derived from 4 different rating scales. The correlation was maintained when presentation of the scales was separated by a series of questions and by physical examination. There is good evidence that the 4 scales are measuring the same underlying pain variable as they calibrate well. There is also evidence that an 11-point (0-10) numerical rating scale performs better than both a 4-point simple descriptive scale or a continuous (visual analogue) scale.

The tension-free hernioplasty

Article

Mar 1989
AM J SURG

Since the first true herniorrhaphy was performed by Bassini over 100 years ago, all modifications and surgical techniques have shared a common disadvantage: suture line tension. The anatomic, physiologic, and pathologic characteristics of hernia recurrence are examined. The prime etiologic factor behind most herniorrhaphy failures is the suturing together, under tension, of structures that are not normally in apposition. With the use of modern mesh prosthetics, it is now possible to repair all hernias without distortion of the normal anatomy and with no suture line tension. The technique is simple, rapid, less painful, and effective, allowing prompt resumption of unrestricted physical activity.

Transcutaneous Electrical Nerve Stimulation for Pain Relief following Inguinal Hernia Repair: A Controlled Trial

Article

Feb 1988

The efficacy of transcutaneous electrical nerve stimulation (TENS) in relieving postoperative pain has been assessed by means of a prospective randomized controlled trial in 62 male patients undergoing unilateral inguinal herniorrhaphy. Thirty-four patients received TENS and 28 patients received sham TENS for 48 h after the operation. Pain was assessed by means of linear analogue pain scales, analgesic requirements and peak expiratory flow readings. We were unable to detect any significant differences in these variables when the two groups were compared. These results do not support the use of TENS.

Controlled Trial of Transcutaneous Electrical Nerve Stimulation (TENS) for Postoperative Pain Relief Following Inguinal Herniorrhaphy

Article

Jan 1987

We have evaluated the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative pain following inguinal herniorrhaphy in a prospective randomized controlled trial. Forty male patients undergoing unilateral inguinal herniorrhaphy for the first time were randomized to receive either active or inactive TENS. Electrical stimulation was delivered by electrodes placed along either side of the wound following operation. An identical apparatus, which did not deliver an electrical current, was applied to control patients. Pain was assessed over the first 3 postoperative days by visual analogue pain scores, expiratory peak flow rates and analgesic requirements. There was no difference between the two groups for pain scores, peak flow rates or analgesic requirements and we conclude that TENS as used in this trial does not reduce postoperative pain. However, TENS had considerable patient appeal and many patients believed that it was effective.

The effects of transcutaneous electrical nerve Stimulation on post-cesarean pain

Article

Dec 1986

The purpose of this study was to examine the effect of continuous transcutaneous electrical nerve stimulation (TENS) near the incision site on post-cesarean pain and on analgesic intake during the early postoperative period. This investigation utilised a 2-group (TENS-treated and placebo TENS-treated), single-blind experimental design. Eighteen multiparous women, each having undergone an elective cesarean delivery, participated in the study. Nine patients received TENS and nine placebo stimulation. The treatment was continuous through to the third day following the day of surgery. The McGill Pain Questionnaire was used to estimate the three most frequent types of post-cesarean-associated pain, and records of the patients' analgesic intake were obtained from hospital charts. The results suggest that TENS was significantly more effective than placebo TENS in reducing cutaneous, movement-associated incisional pain. However, pain resulting from internal structures, i.e., deep pain, afterbirth pain (due to uterine contractions), and the somatic pain associated with decreased peristalsis (gas pains) were not amenable to TENS. No significant differences in analgesic intake were observed. The possible reasons for these findings are discussed.

The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery

Article

Jan 1985
AM J SPORT MED

A prospective study of the use of transcutaneous neural stimulation (TNS) in 90 arthroscopic knee surgery patients was performed to determine: if TNS is as effective as traditional pain medication in treating postoperative knee pain; and if patients that had received TNS regain preoperative motion and strength quicker than the control population. The patients were divided into three equal groups. Group I consisted of patients with no TNS unit, Group II had a "placebo" unit, and Group III had a "live" unit. Preoperatively, each patient received an isokinetic muscle examination, orientation to the TNS unit, leg circumference measurements, and exercise instruction. An isokinetic muscle examination and leg circumference measurements were repeated at 1, 3, and 7 weeks postoperatively. Additionally, the amount of pain and medication required was analyzed. The results of the study indicated that the use of a TNS unit is an effective adjunct in decreasing postoperative pain in 93% of patients. The amount of pain and total pain medication required was greatest in the control group, less in the placebo, and markedly reduced in the TNS group. A comparison among the three groups revealed that the TNS group regained the following preoperative values 1 month sooner than the other two groups (3 as opposed to seven weeks postoperatively): isokinetic power in flexion and extension (P less than 0.05), range of motion (P less than 0.02), and leg volume (P less than 0.05). There was no correlation between the pain and irregular wave forms on the isokinetic graph. The only complication noted was skin irritation at the electrode sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of Risk Factors and Surgical Outcome

Article

Nov 1983
SURG CLIN N AM

Arthur J.L. Schneider

Patients with known cardiac disease who face operative procedures are usually more concerned than other patients because they perceive themselves to be at greater risk. By reviewing several studies of preoperative risk factors, the author attempts to find which factors imply significant risk of mortality in surgical patients with cardiac disease.

Morphine: Controlled trial of different methods of administration for postoperative pain relief

Article

Feb 1980

Forty-five patients who had undergone major operations were given a slow intravenous injection of morphine sulphate (1 mg/ml saline) until their pain was relieved and were then randomly divided into three equal groups to receive different regimens of morphine sulphate over the next 72 hours. Patients in group A received 3.5 times the pain-relieving dose (28-63 mg, mean 36 mg) by continuous intravenous infusion; those in group B received the pain-relieving dose (90-160 mg, mean 110 mg) intramuscularly, four-hourly for the first 24 hours, six-hourly for the next 24 hours, and then eight and 20 hours later; and those in group C received the pain-relieving dose (80-280 mg, mean 140 mg) intramuscularly as required. Pain was assessed on a linear analogue scale and vital capacity and peak expiratory flow rate measured 12-hourly. The mean pain score was significantly lower and respiratory function significantly better in group A than in groups B and C. Only one patient (in group A) required extra morphine. Thus morphine administered by continuous intravenous infusion is superior to other regimens, giving better pain relief at a lower dosage.

The use of pain scales in assessing the efficacy of analgesics in post-operative dental pain

Article

Feb 1982

Robin A Seymour

Two 10 cm visual analogue scales were compared with a 0-10 point numerical rating scale and a four-point verbal descriptive scale, in assessing pain severity in twelve patients with post-operative pain following removal of an impacted lower third molar. High correlations were shown between the pain scores from the two visual analogue scales and the numerical scale, but a lower correlation was obtained when the four-point scale was compared with the other scales. Analgesic efficacy was found to be dependent on the type of scale used. The 10 cm visual analogue scale was more sensitive than other pain scales and could discriminate between small changes in pain intensity.

Presentation and outcome of strangulated external hernia in a district general hospital

Article

May 1981

N.J. Andrews

Two hundred consecutive emergency hernia operations are reviewed. Mortality from this condition has not significantly altered in the past 30 years. Half of the patients presented 48 h or more from the onset of symptoms. Mortality and bowel resection were clearly linked with the duration of symptoms prior to admission. There were no reliable clinical signs to predict the likelihood of bowel strangulation. Recurrent incisional and femoral hernias were associated with high resection rates and mortality. Right-sided hernias appeared to strangulate more frequently than left-sided hernias.

Preemptive Analgesia—Treating Postoperative Pain by Preventing the Establishment of Central Sensitization

Article

Sep 1993
ANESTH ANALG

Control of Postoperative Pain by Transcutaneous Electrical Nerve Stimulation After Thoracic Operations

Article

Apr 1997
ANN THORAC SURG

Transcutaneous electrical nerve stimulation (TENS) has been used extensively to control postoperative pain, but its effects are controversial. This is probably due to the different types of operations performed and, therefore, to the varying intensity of postoperative pain. Here we present an extensive study with TENS in 324 patients who underwent different types of thoracic surgical procedures: posterolateral thoracotomy, muscle-sparing thoracotomy, costotomy, sternotomy, and video-assisted thoracoscopy. Each patient cohort was randomly subdivided into three treatment groups: TENS, placebo TENS and control. The effectiveness of TENS was assessed by two factors: the time from the beginning of treatment to the request for further analgesia and the total medication intake during the first 12 hours after operation. Whereas posterolateral thoracotomy produced severe pain, muscle-sparing thoracotomy, costotomy, and sternotomy caused moderate pain, and video-assisted thoracoscopy caused only mild pain. The TENS treatment was not effective in the posterolateral thoracotomy group, but it was useful as an adjunct to other medications in the muscle-sparing thoracotomy, costotomy, and sternotomy groups. In contrast, representing the only pain control treatment with no adjunct drugs, it was very effective in patients having video-assisted thoracoscopy. These findings show that TENS is useful after thoracic surgical procedures only when postoperative pain is mild to moderate; it is uneffective for severe pain.

Validity of a verbally administered numeric rating scale to measure cancer pain intensity

Article

May 1997

The ability to quantify pain intensity is essential when caring for individuals in pain in order to monitor patient progress and analgesic effectiveness. Three scales are commonly employed: the simple descriptor scale (SDS), the visual analog scale (VAS), and the numeric (pain intensity) rating scale (NRS). Patients with English as a second language may not be able to complete the SDS without translation, and visually, cognitively, or physically impaired patients may have difficulty using the VAS. The NRS has been found to be a simple and valid alternative in some disease states; however, the validity of this scale administered verbally, without visual cues, to oncology patients has not yet been established. The present study examined validity of a verbally administered 0-10 NRS using convergence methods. The correlation between the VAS and the NRS was strong and statistically significant (r = 0.847, p < 0.001), supporting the validity of the verbally administered NRS. Although all subjects were able to complete the NRS and SDS without apparent difficulty, 11 subjects (20%) were unable to complete the VAS. The mean opioid intake was significantly higher for the group that was unable to complete the VAS (mean 170.8 mg, median 120.0 mg, SD = 135.8) compared to the group that had no difficulty with the scale (mean 65.6 mg, 33.0 mg, SD = 99.7) (Mann-Whitney test, p = 0.0065). The verbally administered 0-10 NRS provides a useful alternative to the VAS, particularly as more contact with patients is established via telephone and patients within the hospital are more acutely ill.

Wang B, Tang J, White PF, Naurse R, Sloninsky A, Kariger R, Gold J, Wender RH: Effect of the intensity of transcutaneous acupoint electrical stimulation on the postoperative analgesic requirement

Article

Sep 1997
ANESTH ANALG

Given the inherent side effects associated with both opioid and nonopioid analgesic drugs, a nonpharmacologic therapy that could decrease the need for analgesic medication would be valuable. We designed a sham-controlled study to assess the effect of the intensity of transcutaneous acupoint electrical stimulation (TAES) on postoperative patient-controlled analgesia (PCA) requirement for hydromorphone (HM), the incidence of opioid-related side effects, and the recovery profile after lower abdominal surgery. One hundred one healthy consenting women undergoing lower abdominal procedures with a standardized general anesthetic technique were randomly assigned to one of four postoperative analgesic treatment regimens: Group I (n = 26) PCA only; Group II (n = 25), PCA + sham-TAES (no electrical stimulation); Group III (n = 25), PCA + low-TAES (4-5 mA of electrical stimulation); Group IV (n = 25), PCA + high-TAES (9-12 mA of electrical stimulation). The PCA device was programmed to deliver HM, 0.2-0.4 mg intravenously boluses "on demand," with a minimum lockout interval of 10 min. The TAES skin electrodes were placed at the Hegu acupoint on the nondominant hand and on both sides of the surgical incision. The TAES frequency was set in the dense-and-disperse mode, alternating at 2 Hz and 100 Hz every 3 s, with stimulation of the hand and incision alternated every 6 s. The patients in Groups II-IV were instructed to use TAES every 2 h for 30 min while awake. After discontinuation of PCA, oral pain medications were administered on demand. The postoperative PCA-HM requirement, pain scores, opioid-related side effects, and requirements for antiemetic and antipruritic medication were recorded. High-TAES decreased the HM requirement by 65% and reduced the duration of PCA therapy, as well as the incidence of nausea, dizziness, and pruritus. Low-TAES produced a 34% decrease in the HM requirement compared with only 23% in the "sham" TAES group. We conclude that high-TAES produced a significant decrease in the PCA opioid requirement and opioid-related side effects after low intraabdominal surgery.

Transcutaneous electrical nerve stimulation (TENS) as a pain-relief device in obstetrics and gynecology

Article

Feb 1997
CLIN EXP OBSTET GYN

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological and non-invasive pain-relief method that has been proven effective for a variety of conditions. Electrical therapy has been recognized for a long time but its practical clinical application in the form of TENS has been evaluated only during the last 30 years as a result of several theories on pain. The most known of these with regard to TENS development is the "gate theory", although several others have also played a role. In obstetrics and gynecology, TENS has been found to be effective in alleviating labor pain and in the treatment of primary dysmenorrhea. It has also been used successfully following obstetric and gynecologic surgery. In order to be effective in clinical use for obstetric and gynecologic indications, a TENS device must have certain properties, which are detailed in this review. Although new TENS devices that meet all the necessary requirements have been developed and tested, their use is still far from widespread. Patients and medical staff should be encouraged to try the TENS device for obstetric and gynecologic indications, since it is non-invasive, efficient, and easy to use.

Neurocognitive Deficits in Alcoholics and Social Drinkers: A Continuum?

Article

Jul 1998

Oscar A. Parsons

Our research program has investigated neurocognitive deficits in sober alcoholics for several decades. We have shown that both male and female adult alcoholics--compared with peer nonalcoholic controls--have deficits on tests of learning, memory, abstracting, problem-solving, perceptual analysis and synthesis, speed of information processing, and efficiency. The deficits are equivalent to those found in patients with known brain dysfunction of a mild to moderate nature. Attempts to identify factors other than alcoholism to account for these differences have been unsuccessful. The deficits appear to remit slowly over 4 to 5 years. Relapse of recovering alcoholics is predicted by behavioral (e.g., depressive symptoms and neurocognitive performance) and biological measures (e.g., event-related potentials) obtained at the end of treatment. Results of recent studies support the hypothesis of a continuum of neurocognitive deficits ranging from the severe deficits found in Korsakoff patients to moderate deficits found in alcoholics and moderate to mild deficits in heavy social drinkers (more than 21 drinks/week). Individual differences in the presence and magnitude of neurocognitive deficits in social drinkers and alcoholics are hypothesized to be due, in part, to individual differences in vulnerability of the brain to alcohol or its metabolites' toxic effects.

Esophageal Visceral Pain Sensitivity (Effects of TENS and Correlation with Manometric Findings)

Article

Sep 1998

Increased esophageal visceral sensitivity has been suggested to be an important factor in the development of esophageal chest pain. Transcutaneous electrical nerve stimulation (TENS) has been found effective in the treatment of visceral heart pain in severe angina pectoris, but its effect on esophageal pain perception is not known. In this study, we used the method of graded intraesophageal balloon distension to study the effects of TENS on esophageal motility and pain sensitivity. In addition, we explored the relationship between manometric findings and esophageal susceptibility to pain. TENS reduced symptoms during balloon distension significantly and decreased peristaltic velocity. Increased visceral perception was positively correlated to the amplitude and duration of the esophageal peristalsis. This study suggests a correlation between increased peristaltic waves and visceral perception in the esophagus. TENS appears to reduce esophageal pain sensitivity and thus may be a useful treatment for noncardiac chest pain of esophageal origin.

The Effect of Location of Transcutaneous Electrical Nerve Stimulation on Postoperative Opioid Analgesic Requirement: Acupoint Versus Nonacupoint Stimulation

Article

Dec 1998
ANESTH ANALG

Unlabelled: Transcutaneous electrical nerve stimulation (TENS) has been used as a complementary (supplemental) therapy to opioid analgesics for pain relief after surgery. Simultaneous stimulation at a classical Chinese acupoint site and periincisional dermatomes significantly decreases the postoperative analgesic requirement. This sham-controlled study was designed to assess the relative effectiveness of acupoint versus nonacupoint stimulation on the postoperative hydromorphone (HM) requirement, the incidence of opioid-related side effects, and the overall recovery profile. One hundred women undergoing total abdominal hysterectomy or myomectomy procedures with a standardized general anesthesia were randomly assigned to one of four postoperative analgesic treatment regimens (n = 25 each): Group I = sham-TENS (no electrical current) at the Zusanli (ST36) acupoints, Group II = nonacupoint-TENS at the shoulders, Group III = dermatomal-TENS at the level of the surgical incision, and Group IV = acupoint-TENS at the Zusanli acupoints. The frequency of TENS was set in the standard dense-and-disperse mode of 2/100 Hz. The intensity of stimulation was set at 0 mA for patients in Group I and at 9-12 mA for patients in Groups II, III, and IV. A patient-controlled analgesia (PCA) device programmed to deliver bolus doses of HM 0.2-0.4 mg IV on demand with a minimal lockout interval of 10 min was used to quantify the postoperative opioid analgesic requirement. Standard 100-mm visual analog scales were used to assess pain, as well as sedation, fatigue, and nausea, at specific intervals after surgery. The numbers of PCA demands and delivered bolus doses, requirements for supplemental medication, and any opioid-related side effects were recorded. In the first 24 h postoperatively, the opioid requirements in Groups III and IV were decreased by 37% and 39%, respectively, compared with the control (sham) group and 35% and 38%, respectively, compared with Group II. The duration of PCA usage and the incidences of nausea and dizziness were also significantly decreased in Groups III and IV compared with Groups I and II. We conclude that periincisional dermatomal and Zusanli acupoint stimulation were equally effective in decreasing the postoperative opioid analgesic requirement and in reducing opioid-related side effects. Both of these positions were more effective than the nonacupoint (shoulder) location. Implications: The location of the stimulating electrodes seems to be an important determinant of the efficacy of transcutaneous electrical nerve stimulation in decreasing the need for opioid analgesics in the postoperative period. This study demonstrates that transcutaneous electrical nerve stimulation applied at the dermatomal level of the skin incision is as effective as Zusanli acupoint stimulation, and both were more effective than stimulation at a nonacupoint (shoulder) location.

Pain after primary inguinal herniorrhaphy: Influence of surgical technique

Article

May 1999

Pain is an important problem after ambulatory hernia repair. To assess the influence of the surgical technique on postoperative pain, two separate randomized, patient-blinded, controlled trials were performed in men with an indirect inguinal hernia. In study A, 48 patients with an internal inguinal ring smaller than 1.5 cm were randomly allocated to either simple extirpation of the hernial sac or extirpation plus annulorrhaphy. In study B, 84 patients with an internal inguinal ring wider than 1.5 cm were randomly allocated to extirpation plus annulorrhaphy or extirpation plus Lichtenstein mesh repair (modified). All operations were performed under unmonitored local anesthesia with standardized perioperative analgesia using methadone and tenoxicam. Pain was scored daily for the first postoperative week and after 4 weeks on a four-point verbal-rank scale (no, light, moderate, or severe pain) during rest, while coughing, and during mobilization (rising to the sitting position). Use of supplementary analgesics (paracetamol) was recorded. Cumulative daily pain scores for the first postoperative week and the number of patients who used supplementary analgesics were the main outcome measures. There were no significant differences in cumulative pain scores or use of supplementary analgesics between the treatment groups in either study. Cumulative pain scores were significantly higher during coughing and mobilization than during rest in both studies. Choice of surgical technique for open repair of a primary indirect inguinal hernia has no influence on postoperative pain.

The Effect of Stimulus Frequency on the Analgesic Response to Percutaneous Electrical Nerve Stimulation in Patients with Chronic Low Back Pain

Article

May 1999
ANESTH ANALG

Unlabelled: Low back pain (LBP) is one of the most common medical problems in our society. Increasingly, patients are turning to nonpharmacologic analgesic therapies such as percutaneous electrical nerve stimulation (PENS). We designed this sham-controlled study to compare the effect of three different frequencies of electrical stimulation on the analgesic response to PENS therapy. Sixty-eight consenting patients with LBP secondary to degenerative lumbar disc disease were treated with PENS therapy at 4 Hz, alternating 15 Hz and 30 Hz (15/30 Hz), and 100 Hz, as well as sham-PENS (0 Hz), according to a randomized, cross-over study design. Each treatment was administered for a period of 30 min three times per week for 2 wk. The pre- and posttreatment assessments included the health status survey short form and visual analog scales for pain, physical activity, and quality of sleep. After receiving all four treatments, patients completed a global assessment questionnaire. The sham-PENS treatments failed to produce changes in the degree of pain, physical activity, sleep quality, or daily intake of oral analgesic medications. In contrast, 4-Hz, 15/30-Hz, and 100-Hz stimulation all produced significant decreases in the severity of pain, increases in physical activity, improvements in the quality of sleep, and decreases in oral analgesic requirements (P < 0.01). Of the three frequencies, 15/30 Hz was the most effective in decreasing pain, increasing physical activity, and improving the quality of sleep (P < 0.05). In the global assessment, 40% of the patients reported that 15/30 Hz was the most desirable therapy, and it was also more effective in improving the patient's sense of well-being. We conclude that the frequency of electrical stimulation is an important determinant of the analgesic response to PENS therapy. Alternating stimulation at 15-Hz and 30-Hz frequencies was more effective than either 4 Hz or 100 Hz in improving outcome measures in patients with LBP. Implications: The frequency of electrical stimulation seems to be an important determinant of the analgesic efficacy of percutaneous electrical nerve stimulation. Mixed low- and high-frequency stimulation was more effective than either low or high frequencies alone in the treatment of patients with low back pain.

Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats

Article

Jun 1999

Transcutaneous electrical nerve stimulation (TENS) is commonly used for relief of pain. The literature on the clinical application of TENS is extensive. However, surprisingly few reports have addressed the neurophysiological basis for the actions of TENS. The gate control theory of pain is typically used to explain the actions of high-frequency TENS, whereas, low-frequency TENS is typically explained by release of endogenous opioids. The current study investigated the role of mu, delta, and kappa opioid receptors in antihyperalgesia produced by low- and high-frequency TENS by using an animal model of inflammation. Antagonists to mu (naloxone), delta (naltrinodole), or kappa (nor-binaltorphimine) opioid receptors were delivered to the spinal cord by microdialysis. Joint inflammation was induced by injection of kaolin and carrageenan into the knee-joint cavity. Withdrawal latency to heat was assessed before inflammation, during inflammation, after drug (or artificial cerebral spinal fluid as a control) administration, and after drug (or artificial cerebral spinal fluid) administration + TENS. Either high- (100 Hz) or low- frequency (4 Hz) TENS produced approximately 100% inhibition of hyperalgesia. Low doses of naloxone, selective for mu opioid receptors, blocked the antihyperalgesia produced by low-frequency TENS. High doses of naloxone, which also block delta and kappa opioid receptors, prevented the antihyperalgesia produced by high-frequency TENS. Spinal blockade of delta opioid receptors dose-dependently prevented the antihyperalgesia produced by high-frequency TENS. In contrast, blockade of kappa opioid receptors had no effect on the antihyperalgesia produced by either low- or high-frequency TENS. Thus, low-frequency TENS produces antihyperalgesia through mu opioid receptors and high-frequency TENS produces antihyperalgesia through delta opioid receptors in the spinal cord.

Effect of the Frequency of Transcutaneous Electrical Nerve Stimulation on the Postoperative Opioid Analgesic Requirement and Recovery Profile

Article

Dec 1999

Transcutaneous electrical nerve stimulation (TENS) at either an acupoint or dermatome corresponding to the surgical incision produces comparable decreases in postoperative opioid requirements and opioid-related side effects. However, the effect of the frequency of the electrical stimulus on the postoperative analgesic response to TENS therapy has not been studied. One hundred women undergoing major gynecological procedures with a standardized general anesthetic technique were enrolled in the study. Patients were randomly assigned to four groups: group I, patient-controlled analgesia (PCA) plus sham TENS (no stimulation); group II, PCA plus low-frequency (2-Hz) TENS; group m, PCA plus high-frequency (100-Hz) TENS; group IV, PCA plus mixed-frequency (2- and 100-Hz) TENS. The PCA device was programmed to deliver 2-3 mg intravenous boluses of morphine with a lockout interval of 10 min. The TENS device was used every 2 h during the day. Standard 100-mm visual analog scales were used to assess pain, sedation, fatigue, and nausea at specific intervals after surgery. Mixed frequency (2 and 100 Hz) of stimulation decreased morphine requirements by 53% compared with the sham group; low (2-Hz) and high (100-Hz) frequencies produced 32% and 35% decreases, respectively. All three "active" TENS groups reduced the duration of PCA therapy, as well as the incidence of nausea, dizziness, and itching. TENS decreased postoperative opioid analgesic requirements and opioid-related side effects when utilized as an adjunct to PCA after lower abdominal surgery. Use of TENS at mixed (2- and 100-Hz) frequencies of stimulation produced a slightly greater opioid-sparing effect than either low (2-Hz) or high (100 Hz) frequencies alone.

Transcutaneous Electrical Nerve Stimulation as an Alternative Therapy for Microlaryngeal Endoscopic Surgery

Article

Dec 1999
ANESTH ANALG

Differences Between the sexes in post-surgical pain

Article

Mar 2000

It has been shown that women have a lower pain threshold and lower tolerance to some forms of experimental pain then men. However, the evidence that clinical pain is perceived differently by the two sexes is not yet as strong. The placement of intraoral implants is a highly controlled surgical procedure that we have used to investigate this possibility. Forty-eight edentulous (without teeth) subjects (27 females), aged from 35 to 63 years, received two titanium implants in the anterior mandible under local anesthesia. After the surgery, subjects completed a pain diary three times each day, rating pain intensity and unpleasantness on 100 mm visual analog scales (VAS). Once a day, they chose verbal descriptors from the McGill Pain Questionnaire (MPQ). Age of subjects, duration of surgery, the amount of local anesthetic used and the amount of pain medication taken were not statistically different for the two groups (P>/=0.32). Results showed that the senior surgeon produced significantly less pain than a 4th year resident (P=0.04). Although there were no significant differences between sexes for mean daily ratings of intensity or unpleasantness over time (P>/=0.10), most women experienced the highest intensity of pain during the day, while most men had higher pain in the evening (P=0.025). Also, the relative unpleasantness (unpleasantness/intensity ratio) increased significantly with time for males, but not for females (P=0.016). Males and females did not differ in the total number of words chosen from the MPQ (P=0.61), or in the averaged Pain Rating Index (PRI) (P=0.53). However, women used significantly more evaluative words than men (P=0.04), suggesting that woman found the overall intensity greater. These results indicate that women find post-surgical pain more intense than males, but that men are more disturbed than women by low levels of pain that last several days.

Transcutaneous electrical nerve stimulation and acupuncture-like transcutaneous electrical nerve stimulation for chronic low back pain (Withdrawn Paper. 1997 art no. CD000210)

Article

Feb 2000

Transcutaneous electrical nerve stimulation (TENS), originally based on the gate-control theory of pain, is widely used for the treatment of chronic low back pain. Despite its wide use and theoretical rationale, there appears at first glance little scientific evidence to support its use. This Cochrane review examines the available evidence on TENS for the treatment of chronic back pain through an exhaustive search of the literature. Transcutaneous electrical nerve stimulation (TENS) and acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) for chronic low back pain management have experienced a tremendous growth over the past 25 years. The objective of this review was to assess the effects of TENS and ALTENS for reducing pain and improving function in patients with chronic back pain. We searched MEDLINE up to November 1997, EMBASE from 1985 to September 1995, Amed and Ciscom to January 1995, reference lists of the retrieved articles, proceedings of conferences and contacted investigators in the field. Randomised trials comparing TENS or ALTENS therapy to placebo in patients with chronic low back pain. Two reviewers independently assessed trial quality and extracted data on pain reduction, range of movement, functional and work status. Six trials were included. The trials included 288 participants with an average age range of 45 to 50 years and approximately equal numbers of women and men. The overall odds ratio for improvement in pain for each comparison was: TENS/ALTENS versus placebo 2.11 (95% confidence interval 1.32 to 3. 38), ALTENS versus placebo 7.22 (95% confidence interval 2.60 to 20.01) and TENS versus placebo 1.52 (95% confidence interval 0.90 to 2.58). The odds ration for improvement in range of motion on ALTENS versus placebo was 6.61 (95% confidence interval 2.36 to 18.55). There is evidence from the limited data available that TENS/ALTENS reduces pain and improves range of motion in chronic back pain patients, at least in the short term. A large trial of ALTENS and TENS is needed to confirm these findings.

The Use of Transcutaneous Acupoint Electrical Stimulation for Preventing Nausea and Vomiting After Laparoscopic Surgery

Article

Apr 2001
ANESTH ANALG

Unlabelled: Nonpharmacologic techniques may be effective in preventing postoperative nausea and vomiting (PONV). This sham-controlled, double-blinded study was designed to examine the antiemetic efficacy of transcutaneous acupoint electrical stimulation (TAES) in a surgical population at high risk of developing PONV. We studied 221 outpatients undergoing laparoscopic cholecystectomy with a standardized general anesthetic technique in this randomized, multicenter trial. In the TAES group, an active ReliefBand(Woodside Biomedical, Inc., Carlsbad, CA) device was placed at the P6 acupoint, whereas in the Sham and Placebo groups, an inactive device was applied at the P6 acupoint and at the dorsal aspect of the wrist, respectively. The ReliefBand was applied after completion of electrocautery and remained in place for 9 h after surgery. The incidence of PONV and need for "rescue" medication were evaluated at predetermined time intervals. TAES was associated with a significantly decreased incidence of moderate-to-severe nausea as denoted on the Functional Living Index-Emesis score for up to 9 h after surgery (5%-11% for the TAES group vs 16%-38% [P < 0.05] and 15%-26% [P < 0.05] for Sham and Placebo groups, respectively). TAES was also associated with a larger proportion of patients free from moderate to severe nausea symptoms (73% vs 41% and 49% for Sham and Placebo groups, respectively; P < 0.05). However, there were no statistically significant differences among the three groups with regard to incidence of vomiting or the need for rescue antiemetic drugs. We conclude that TAES with the ReliefBand at the P6 acupoint reduces nausea, but not vomiting, after laparoscopic cholecystectomy. Implications: Transcutaneous acupoint electrical stimulation at the P6 acupoint reduced postoperative nausea, but not vomiting, in outpatients undergoing laparoscopic cholecystectomy procedures.

Reduction in inflammation-induced sensitization of dorsal horn neurons by transcutaneous electrical nerve stimulation in anesthetized rats

Article

Apr 2001

Transcutaneous electrical nerve stimulation (TENS) is utilized to treat a variety of painful conditions. Inflamed animals present with an increased response to noxious stimuli, i.e., hyperalgesia, at the site of injury (primary hyperalgesia) and outside the site of injury (secondary hyperalgesia). Further, following acute inflammation, dorsal horn neurons show an increased responsiveness to peripherally applied stimuli, which has been termed sensitization. Previous studies demonstrate a reduction in dorsal horn neuron activity following TENS treatment in normal animals and a reduction in primary and secondary hyperalgesia in acutely inflamed animals. The purpose of this study was to examine the effects of TENS on dorsal horn neurons sensitized by acute inflammation. Extracellular recordings from wide dynamic range (WDR), high threshold (HT) and low threshold (LT) dorsal horn neurons in anesthetized rats were assessed for spontaneous activity, responses to innocuous and noxious mechanical stimulation and receptive field size. Responses were measured before and 3 h after induction of inflammation, and immediately and 1 h after application of either high (100 Hz) or low (4 Hz) frequency TENS (motor intensity, pulse duration = 100 microseconds). TENS was applied to the inflamed paw to encompass the receptive field of the neuron for 20 min. WDR and HT dorsal horn neurons sensitized to mechanical stimulation after induction of inflammation. Application of either high or low frequency TENS to the inflamed paw reduced both innocuous and noxious evoked responses of WDR and HT dorsal horn neurons immediately and 1 h after treatment with TENS. Comparison of responses after TENS with baseline responses showed that the evoked responses in the majority of WDR and HT cells returned to or fell below baseline responses. TENS had no effect on responses of LT neurons. In summary, central neuron sensitization is reduced by TENS and may underlie the reduction in hyperalgesia observed after treatment with TENS.

Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS)

Article

Jul 2001

Although transcutaneous electrical nerve stimulation (TENS) is used extensively in inflammatory joint conditions such as arthritis, the underlying mechanisms are unclear. This study aims to demonstrate an opiate-mediated activation of descending inhibitory pathways from the rostral ventral medulla (RVM) in the antihyperalgesia produced by low- (4 Hz) or high-frequency (100 Hz) TENS. Paw withdrawal latency to radiant heat, as an index of secondary hyperalgesia, was recorded before and after knee joint inflammation (induced by intra-articular injection of 3% kaolin and carrageenan) and after TENS/no TENS coadministered with naloxone (20 microg/1 microl), naltrindole (5 microg/1 microl), or vehicle (1 microl) microinjected into the RVM. The selectivity of naloxone and naltrindole doses was tested against the mu-opioid receptor agonist [D-Ala2,N-Me-Phe4,Gly-ol5]-enkephalin (DAMGO) (20 ng, 1 microl) and the delta2-opioid receptor agonist deltorphin (5 microg, 1 microl) in the RVM. Naloxone microinjection into the RVM blocks the antihyperalgesia produced by low frequency (p < 0.001), but not that produced by high-frequency TENS (p > 0.05). In contrast, naltrindole injection into the RVM blocks the antihyperalgesia produced by high-frequency (p < 0.05), but not low-frequency (p > 0.05) TENS. The analgesia produced by DAMGO and deltorphin is selectively blocked by naloxone (p < 0.05) and naltrindole (p < 0.05), respectively. Thus, the dose of naloxone and naltrindole used in the current study blocks mu- and delta-opioid receptors, respectively. Hence, low-frequency and high-frequency TENS produces antihyperalgesia by activation of mu- and delta-opioid receptors, respectively, in the RVM.

Transcutaneous Electrical Nerve Stimulation Does Not Augment Epidural Labor Analgesia

Article

Jan 2002
J CLIN ANESTH

To evaluate whether transcutaneous electrical nerve stimulation (TENS) can increase the quality and duration of an initiation dose of bupivacaine used for the establishment of epidural labor analgesia. Randomized, double-blind study. Tertiary-care academic medical center. 40 ASA physical status I and II parturients in early, active spontaneous labor with a singleton, vertex term fetus, and requesting analgesia. A standardized epidural technique with either an active or inactive TENS unit was performed. Before epidural placement, TENS intensity thresholds were determined with electrodes placed over the paraspinus muscles at T(10)-L(1), and S(2)-S(4); TENS settings for mode, cycle, and pulse width were standardized. Data were collected at timed intervals on pain as measured by visual analog scale (VAS), sensory level (pinprick), motor blockade (Bromage score), cervical dilation, and duration of analgesia. The duration of analgesia produced by the initial dose of epidural bupivacaine did not differ between groups (TENS turned off 82.3 +/- 26 [mean +/- SD] vs. TENS activated 80.7 +/- 40 min, p = 0.88). Kaplan-Meier survival analysis and Mantel-Cox log rank analysis showed no difference between the two treatments (p = 0.75). No difference in the quality of analgesia was observed between the two groups. In healthy laboring parturients, the application of a TENS unit did not alter the quality or duration of an initiation dose of bupivacaine utilized for the establishment of epidural labor analgesia.

The Role of Non-Opioid Analgesic Techniques in the Management of Pain After Ambulatory Surgery

Article

Apr 2002
ANESTH ANALG

Paul F White

As more extensive and painful surgical procedures (e.g., laparoscopic cholecystectomy, adrenalectomy, and nephrectomy, as well as prostatectomy, laminectomy, shoulder and knee reconstructions, and hysterectomy) are performed on an outpatient or short-stay basis, the use of multimodal perioperative analgesic regimens containing non-opioid analgesic therapies will probably assume an increasingly important role in facilitating the recovery process and improving patient satisfaction (3). Optimizing pain management is necessary to maximize the benefits of ambulatory surgery for both patients and health care providers. Additional outcome studies are needed to validate the beneficial effects of these newer therapeutic approaches with respect to important recovery variables (e.g., resumption of normal activities and return to work). Although many factors other than pain per se must be controlled to minimize postoperative morbidity and facilitate the recovery process after ambulatory surgery, pain remains a major concern of all patients undergoing surgical procedures (102). It is clear that the anesthetic technique can influence the analgesic requirement in the early postoperative period. Although opioid analgesics will continue to play an important role in the management of moderate to severe pain after surgery, the adjunctive use of nonopioid analgesics will probably assume a greater role in the future. Although opioid-free anesthesia may not yet be feasible for major intracavitary surgical procedures, it is becoming increasingly popular for superficial procedures in the ambulatory or office-based setting (103-105). In addition to the local anesthetics, NSAIDs, acetaminophen, and ketamine, nonopioid drugs such as adenosine, β-blockers, α2-agonists, and steroids have also been shown to be potentially useful adjuvants during or after surgery (82,106-112). Use of analgesic drug combinations with differing mechanisms of action may provide additive or even synergistic effects with respect to improving pain control and facilitating the recovery process. Finally, safer, simpler, and less costly analgesic drug delivery systems are needed to provide for more cost-effective pain relief in the postdischarge period after ambulatory surgery. In conclusion, "stress-free" anesthesia with minimal postoperative discomfort should be achievable for the majority of outpatients undergoing ambulatory surgical procedures, with the appropriate use of multimodal analgesic techniques. The aim of the analgesic technique should be not only to lower the pain scores, but more importantly to facilitate earlier mobilization and rehabilitation by reducing complications after discharge home. Recent evidence suggests that clinicians can more effectively prevent postoperative pain and improve the recovery profile after ambulatory surgery by using a combination of preemptive multimodal techniques involving both centrally and peripherally acting analgesic drugs, as well as nonpharmacologic therapies.

Rushton DN Electrical stimulation in the treatment of pain

Article

Jun 2002

David N Rushton

To review the published literature concerning the treatment of painful conditions using devices that deliver electrical stimulation to nervous structures. The review briefly surveys the results obtained using surface electrodes ("TENS") as well as implanted devices. The method used is a critical review of the important published literature up to mid-1999. References were obtained using Medline and the keywords "pain", together with "electrical", "stimulation", "neurostimulation" or "TENS". Electrical stimulation has been found to be of potential benefit in the management of a range of painful conditions. Adequately controlled trials of electrical stimulation are often difficult to achieve. Implanted devices tend to be used in the more severe intractable pain conditions. It is likely that there is more than one mechanism of action. The mechanisms of action are however still often poorly understood, even though historically theoretical and experimental advances in the understanding of pain mechanisms prompted the development of clinical systems and the institution of clinical studies. TENS has proved to be remarkably safe, and provides significant analgesia in about half of patients experiencing moderate predictable pain. Implanted devices can be more effective, but they carry a risk of device failure, implant infection or surgical complication, and are reserved for the more severe intractable chronic pains. The main implanted devices used clinically are the spinal cord stimulator and the deep brain stimulator.

Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain

Article

Feb 2003

We investigated the literature of randomised placebo-controlled trials to find out if transcutaneous electrical nerve stimulation (TENS) or acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) can reduce analgesic consumption after surgery. Subgroup analysis for adequate treatment (pulse frequency: 1-8Hz [ALTENS] or 25-150Hz [TENS], current intensity: "strong, definite, subnoxious, maximal tolerable" or above 15mA, and electrode placement in the incision area) were performed. Twenty-one randomised, placebo-controlled trials with a total of 1350 patients were identified. For all trials, the mean reduction in analgesic consumption after TENS/ALTENS was 26.5% (range -6 to +51%) better than placebo. Eleven of the trials compromising 964 patients, had reports which stated that a strong, subnoxious electrical stimulation with adequate frequency was administered. They reported a mean weighted reduction in analgesic consumption of 35.5% (range 14-51%) better than placebo. In nine trials without explicit confirmation of sufficient current intensity and adequate frequency, the mean weighted analgesic consumption was 4.1% (range -10 to +29%) in favour of active treatment. The difference in analgesic consumption was significantly (p=0.0002) in favour of adequate stimulation. The median frequencies used in trials with optimal treatment was 85Hz for TENS and 2Hz in the only trial that investigated ALTENS. TENS, administered with a strong, subnoxious intensity at an adequate frequency in the wound area, can significantly reduce analgesic consumption for postoperative pain.

Effectiveness of Transcutaneous Electrical Nerve Stimulation on Postoperative Pain With Movement

Article

Nov 2003
J PAIN

This study tested the effectiveness of episodic transcutaneous electrical nerve stimulation (TENS) as a supplement to pharmacologic analgesia on pain with movement and at rest after abdominal surgery and evaluated whether its use during walking and vital capacity maneuvers enhances performance of these activities. TENS, with a modulated frequency, intensity as high as the subject could tolerate, and electrodes placed on either side and parallel to the incision, was compared to placebo TENS and pharmacologic analgesia alone (control) by using a crossover design. Self-report of pain intensity, walking function, and vital capacity were assessed on 33 subjects. TENS resulted in significantly less pain than the control during both walking (P <.5) and vital capacity activities (P <.1) and significantly less pain than placebo TENS during vital capacity (P <.01). TENS also produced significantly better gait speeds than the control (P <.05) and greater gait distances (P <.01) than the control and placebo TENS. Vital capacity and pain intensity at rest were not significantly different among the 3 treatments. These results suggest TENS reduces pain intensity during walking and deep breathing and increases walking function postoperatively when used as a supplement to pharmacologic analgesia. The lack of effect on pain at rest supports the hypothesis that TENS works through reducing hyperalgesia.

[Lichtenstein's hernioplasty]

Article

May 2004

In recent years in Hungary similarly to the worldwide trend the treatment of inguinal hernias has changed. New tension-free methods were developed and--after the introduction by the Department of Surgery, Medical Faculty, University of Pécs--Lichtenstein's method is widely used. Lichtenstein's method has become the gold standard at our department because of its highly favourable results: simple technique, minimal postoperative pain, recurrence rate below 1%, short hospital stay, very low complication rate and early return to physical activity.

Comparison of Stochastic vs. Conventional Transcutaneous Electrical Stimulation for Pain Modulation in Patients with Electromyographically Documented Radiculopathy

Article

Sep 2004

To determine if a transcutaneous electrical stimulation (TENS) unit modified to deliver electrical impulses at random (R) or stochastic frequency, called TENS-R, provided better pain relief than conventional TENS. A prospective, randomized, double-blinded, placebo-controlled study at an urban teaching hospital. A total of 13 adult subjects with radiculopathy on electromyogram and chronic radicular pain rated pain before and after walking 100 feet with proximal (axial) placement of TENS leads with randomized settings on conventional TENS, placebo, or TENS-R and, subsequently, with distal (limb) placement of TENS leads with randomized settings, all on the same day. The pain measures used were the McGill Pain Questionnaire, parts 1 and 2, and the Visual Analog Scale. The functional measure was speed of walking. Four men and seven women completed the study pain scores, measured by McGill Pain Questionnaire part 2, significantly improved when the patient used TENS-R vs. conventional TENS (P = 0.006, analysis of variance). Placement of TENS electrodes on the back significantly decreased pain compared with lead placement on the legs for McGill Pain Questionnaire part 1 (P = 0.007), McGill Pain Questionnaire part 2 (P = 0.042), and the Visual Analog Scale (P = 0.026) measures. Qualitative pain scores significantly improved when the patient used TENS-R vs. conventional TENS. Lead placement of any TENS modality over the back vs. over the leg improved all pain scores.

Hypoalgesic Effect of the Transcutaneous Electrical Nerve Stimulation Following Inguinal Herniorrhaphy: A Randomized, Controlled Trial

Abstract

No full-text available

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