1
|
Johnson MI. Resolving Long-Standing Uncertainty about the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:378. [PMID: 33919821 PMCID: PMC8070828 DOI: 10.3390/medicina57040378] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/18/2021] [Accepted: 04/12/2021] [Indexed: 12/26/2022]
Abstract
Pain is managed using a biopsychosocial approach and pharmacological and non-pharmacological treatments. Transcutaneous electrical nerve stimulation (TENS) is a technique whereby pulsed electrical currents are administered through the intact surface of the skin with the intention of alleviating pain, akin to 'electrically rubbing pain away'. Despite over 50 years of published research, uncertainty about the clinical efficacy of TENS remains. The purpose of this comprehensive review is to critically appraise clinical research on TENS to inform future strategies to resolve the 'efficacy-impasse'. The principles and practices of TENS are described to provide context for readers unfamiliar with TENS treatment. The findings of systematic reviews evaluating TENS are described from a historical perspective to provide context for a critical evaluation of factors influencing the outcomes of randomized controlled trials (RCTs); including sample populations, outcome measures, TENS techniques, and comparator interventions. Three possibilities are offered to resolve the impasse. Firstly, to conduct large multi-centered RCTs using an enriched enrolment with randomized withdrawal design, that incorporates a 'run-in phase' to screen for potential TENS responders and to optimise TENS treatment according to individual need. Secondly, to meta-analyze published RCT data, irrespective of type of pain, to determine whether TENS reduces the intensity of pain during stimulation, and to include a detailed assessment of levels of certainty and precision. Thirdly, to concede that it may be impossible to determine efficacy due to insurmountable methodological, logistical and financial challenges. The consequences to clinicians, policy makers and funders of this third scenario are discussed. I argue that patients will continue to use TENS irrespective of the views of clinicians, policy makers, funders or guideline panel recommendations, because TENS is readily available without prescription; TENS generates a pleasant sensory experience that is similar to easing pain using warming and cooling techniques; and technological developments such as smart wearable TENS devices will improve usability in the future. Thus, research is needed on how best to integrate TENS into existing pain management strategies by analyzing data of TENS usage by expert-patients in real-world settings.
Collapse
Affiliation(s)
- Mark I Johnson
- Centre for Pain Research, Leeds Beckett University, Leeds LS1 3HE, UK
| |
Collapse
|
2
|
Van Boekel RLM, Timmerman H, Bronkhorst EM, Ruscheweyh R, Vissers KCP, Steegers MAH. Translation, Cross-Cultural Adaptation, and Validation of the Pain Sensitivity Questionnaire in Dutch Healthy Volunteers. Pain Res Manag 2020; 2020:1050935. [PMID: 32774564 PMCID: PMC7397447 DOI: 10.1155/2020/1050935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Abstract
An increased sensitivity to painful stimuli has been proposed to be related to the development of chronic pain. Therefore, assessment of individual pain sensitivity is useful in clinical practice. However, experimental pain testing may be uncomfortable for patients and requires specific equipment. The Pain Sensitivity Questionnaire (PSQ) has been developed to facilitate assessment of pain sensitivity. In this study, we aimed to translate and cross-culturally adapt the PSQ from its published German and English versions into the Dutch language and to assess validity of the PSQ in healthy volunteers. After translation and cross-cultural adaptation of the PSQ following international guidelines, we validated the PSQ in 394 healthy volunteers by comparing the PSQ-values with two different experimental pain tests: electrical pain tolerance (EPT) and pressure pain threshold (PPT). In addition, ratings of pain intensity during these tests were obtained on the numerical rating scale (NRS, 0-10). We found that the reliability of the PSQ based on internal consistency was good (Cronbach's alpha 0.90). PSQ-scores, adjusted for age and sex, were statistically significant and weakly inversely correlated to EPT (PSQ-moderate: rho = -0.24, p=0.007; PSQ-total: rho = -0.22, p=0.016). No statistically significant correlation between PSQ-scores and PPT was found. Concerning the pain scores, PSQ-scores were weakly to moderately correlated to EPT-NRS (PSQ-minor: rho = 0.21, p=0.021; PSQ-moderate: rho = 0.22, p=0.016; PSQ-total: rho = 0.23, p=0.009) as well as PPT-NRS (PSQ-minor: rho = 0.32, p < 0.001; PSQ-moderate: rho = 0.36, p < 0.001; PSQ-total: rho = 0.37, p < 0.001). Therefore, we concluded that the Dutch version of the PSQ is culturally appropriate for assessing self-reported pain sensitivity in healthy volunteers.
Collapse
Affiliation(s)
- Regina L. M. Van Boekel
- Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hans Timmerman
- Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Anesthesiology, Pain Center, University Medical Center Groningen, Groningen, Netherlands
| | - Ewald M. Bronkhorst
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ruth Ruscheweyh
- Department of Neurology, Ludwig Maximilians University of Munich, Munich, Germany
| | - Kris C. P. Vissers
- Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Monique A. H. Steegers
- Department of Anesthesiology Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Anesthesiology, Amsterdam University Medical Center, Location VU, Amsterdam, Netherlands
| |
Collapse
|
3
|
Soltanzadeh R, Afsharipour E, Shafai C. Investigation of transcutaneous electrical nerve stimulation improvements with microneedle array electrodes based on multiphysics simulation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3318. [PMID: 32017406 DOI: 10.1002/cnm.3318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 06/10/2023]
Abstract
This paper investigates microneedle array electrodes for transcutaneous electrical nerve stimulation, and compares their performance with conventional surface electrodes. A three-dimensional model of tissue was developed for finite element multiphysics simulations. Investigations included current density in different depths of a tissue, space constant under electrodes, specific absorption ratio of tissue, selectivity of stimulation, temperature rise, and blood flow. Results showed that microneedle electrodes have up to 10% higher selectivity than the surface electrodes. Furthermore, it was found that stimulation using microneedle electrodes provides more robust current density at different tissue depths compared to the surface electrode stimulation. Microneedle electrodes showed enhanced stimulation parameters, particularly for targeting a specific nerve in a specific depth of a tissue.
Collapse
Affiliation(s)
- Ramin Soltanzadeh
- Biomedical Engineering Graduate Program, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elnaz Afsharipour
- Electrical and Computer Engineering Department, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cyrus Shafai
- Electrical and Computer Engineering Department, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
4
|
Vance CG, Chimenti RL, Dailey DL, Hadlandsmyth K, Zimmerman MB, Geasland KM, Williams JM, Merriwether EN, Alemo Munters L, Rakel BA, Crofford LJ, Sluka KA. Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia. J Pain Res 2018; 11:2269-2278. [PMID: 30349353 PMCID: PMC6188186 DOI: 10.2147/jpr.s168297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Introduction Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention clinically used for pain relief. The importance of utilizing the adequate stimulation intensity is well documented; however, clinical methods to achieve the highest possible intensity are not established. Objectives Our primary aim was to determine if exposure to the full range of clinical levels of stimulation, from sensory threshold to noxious, would result in higher final stimulation intensities. A secondary aim explored the association of pain, disease severity, and psychological variables with the ability to achieve higher final stimulation intensity. Methods Women with fibromyalgia (N=143) were recruited for a dual-site randomized controlled trial - Fibromyalgia Activity Study with TENS (FAST). TENS electrodes and stimulation were applied to the lumbar area, and intensity was increased to sensory threshold (ST), then to "strong but comfortable" (SC1), then to "noxious" (N). This was followed by a reduction to the final stimulation intensity of "strong but comfortable" (SC2). We called this the Setting of Intensity of TENS (SIT) test. Results There was a significant increase from SC1 (37.5 mA IQR: 35.6-39.0) to SC2 (39.2 mA IQR: 37.1-45.3) (p<0.0001) with a mean increase of 1.7 mA (95% CI: 1.5, 2.2). Linear regression analysis showed that those with the largest increase between SC1 and N had the largest increase in SC2-SC1. Further, those with older age and higher anxiety were able to achieve greater increases in intensity (SC2-SC1) using the SIT test. Conclusion The SC2-SC1 increase was significantly associated with age and anxiety, with greater mean increases associated with older age and higher anxiety. Thus, although all patients may benefit from this protocol, older women and women with elevated anxiety receive the greatest benefit.
Collapse
Affiliation(s)
- Carol Gt Vance
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,
| | - Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,
| | | | - M Bridget Zimmerman
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Katharine M Geasland
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,
| | - Jonathan M Williams
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, USA
| | - Ericka N Merriwether
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA, .,Department of Physical Therapy, New York University, New York, NY, USA
| | - Li Alemo Munters
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, USA
| | | | - Leslie J Crofford
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, USA
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, The University of Iowa Carver College of Medicine, Iowa City, IA, USA,
| |
Collapse
|
5
|
Downs ME, Lee SA, Yang G, Kim S, Wang Q, Konofagou EE. Non-invasive peripheral nerve stimulation via focused ultrasound in vivo. Phys Med Biol 2018; 63:035011. [PMID: 29214985 DOI: 10.1088/1361-6560/aa9fc2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Focused ultrasound (FUS) has been employed on a wide range of clinical applications to safely and non-invasively achieve desired effects that have previously required invasive and lengthy procedures with conventional methods. Conventional electrical neuromodulation therapies that are applied to the peripheral nervous system (PNS) are invasive and/or non-specific. Recently, focused ultrasound has demonstrated the ability to modulate the central nervous system and ex vivo peripheral neurons. Here, for the first time, noninvasive stimulation of the sciatic nerve eliciting a physiological response in vivo is demonstrated with FUS. FUS was applied on the sciatic nerve in mice with simultaneous electromyography (EMG) on the tibialis anterior muscle. EMG signals were detected during or directly after ultrasound stimulation along with observable muscle contraction of the hind limb. Transecting the sciatic nerve downstream of FUS stimulation eliminated EMG activity during FUS stimulation. Peak-to-peak EMG response amplitudes and latency were found to be comparable to conventional electrical stimulation methods. Histology along with behavioral and thermal testing did not indicate damage to the nerve or surrounding regions. The findings presented herein demonstrate that FUS can serve as a targeted, safe and non-invasive alternative to conventional peripheral nervous system stimulation to treat peripheral neuropathic diseases in the clinic.
Collapse
Affiliation(s)
- Matthew E Downs
- Departments of Biomedical Engineering, Columbia University, New York, NY 10032, United States of America
| | | | | | | | | | | |
Collapse
|
6
|
Tantawy SA, Kamel DM, Abdelbasset WK. Does transcutaneous electrical nerve stimulation reduce pain and improve quality of life in patients with idiopathic chronic orchialgia? A randomized controlled trial. J Pain Res 2017; 11:77-82. [PMID: 29343983 PMCID: PMC5749563 DOI: 10.2147/jpr.s154815] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Chronic orchialgia is defined as testicular pain, which may be either unilateral or bilateral, lasting for more than 3 months. It disturbs a patient’s daily activities and quality of life (QoL), inciting the patient to search for treatments to alleviate the pain. It is estimated that 25% of chronic orchialgia cases are idiopathic. Purpose The purpose of this study was to investigate how effective transcutaneous electrical nerve stimulation (TENS) is in pain reduction and how it consequently affects the QoL in patients with idiopathic chronic orchialgia (ICO). Patients and methods Seventy-one patients were randomly assigned to group A (study group), which included 36 patients who received TENS and analgesia, and group B (control group), which included 35 patients who received analgesia only. The outcome measures were the participants’ demographic data and results of the visual analog scale (VAS) and QoL questionnaire. These outcomes were measured before and after 4 weeks of treatment and at 2-month follow-up. Results The results showed that compared to pretreatment, there was a significant reduction in pain postintervention and at 2-month follow-up in group A (P<0.0001 and <0.001, respectively; F=7.1) as well as a significant improvement in QoL at these time points (P<0.0001 and <0.0001, respectively). There were no significant differences in the VAS score and QoL in group B at different time points of evaluation. Conclusion The findings indicate that TENS is effective in reducing pain and improving patients’ QoL in cases of ICO. TENS is an easy-to-use, effective, noninvasive, and simple method for ICO-associated pain control and QoL improvement.
Collapse
Affiliation(s)
- Sayed A Tantawy
- Department of Physiotherapy, Centre of Radiation, Oncology and Nuclear Medicine, Cairo University, Giza, Egypt.,Department of Physiotherapy, College of Medical and Health Sciences, Ahlia University, Manama, Kingdom of Bahrain
| | - Dalia M Kamel
- Department of Physical Therapy for Obstetrics & Gynecology, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walid Kamal Abdelbasset
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdul Aziz University, Alkharj, Saudi Arabia.,Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| |
Collapse
|
7
|
The Vascular Factor Plays the Main Role in the Cause of Pain in Men with Chronic Prostatitis and Chronic Pelvic Pain Syndrome: The Results of Clinical Trial on Thermobalancing Therapy. Diseases 2017; 5:diseases5040025. [PMID: 29117111 PMCID: PMC5750536 DOI: 10.3390/diseases5040025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 12/27/2022] Open
Abstract
Chronic pain in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), NIH category III is difficult to treat without understanding its cause. The main symptom of chronic prostatitis is pain. In this study, we would like to explain the origin of pain in men with CP/CPPS and its therapy. Forty-five patients with CP/CPPS have received thermobalancing therapy (TT) enabled by Dr Allen's therapeutic device (DATD) for six months as mono-therapy. The control group comprised 45 men with CP/CPPS did not receive TT. Before and after six months the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores, prostatic volume (PV) by ultrasound measurement and uroflowmetry (Qmax) were compared between the groups. Baseline characteristics have shown no difference. After TT, significant improvements in pain score (p < 0.001), quality of life index (QoL) (p < 0.001), decrease of PV (p < 0.001), and increase Qmax (p < 0.001) were determined. There were not noteworthy changes in the control group. Chronic pain due to CP/CPPS happens as a consequence and challenges at the capillary level, namely pathological capillary activity. In response to initial triggers-such as inflammation, cold, psychological and other factors-constriction and spontaneous expansion of capillaries follows, creating a continuous secondary trigger-i.e., the micro-focus of hypothermia-which in turn provokes expansion of capillaries. The additional tissue due to vascular changes into the prostate increases pressure on nociceptors causing pain. TT relieves chronic pelvic pain by eliminating the lasting focus of hypothermia in the affected prostate tissue.
Collapse
|
8
|
Roquet F, Guezouli L, Wachowska B, Balcan I, Montravers P, Longrois D, Guglielminotti J. Comparison of three stimulation sites on the pupillary dilation reflex amplitude evoked by a standardized noxious test. Anaesth Crit Care Pain Med 2017; 36:365-369. [PMID: 28756328 DOI: 10.1016/j.accpm.2017.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 06/08/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Florian Roquet
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
| | - Laila Guezouli
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
| | - Bozena Wachowska
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
| | - Iulia Balcan
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France.
| | - Philippe Montravers
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris 7 Diderot, Sorbonne Paris Cité, Paris, France; Inserm U1148, Paris, France.
| | - Dan Longrois
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Université Paris 7 Diderot, Sorbonne Paris Cité, Paris, France; Inserm U1148, Paris, France.
| | - Jean Guglielminotti
- Département d'anesthésie-réanimation, hôpital Bichat-Claude-Bernard, AP-HP, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Inserm, UMR 1137, IAME, 16, rue Henri-Huchard, 75018 Paris, France.
| |
Collapse
|