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Heiland LD, Owen JM, Nguyen SA, Labadie RF, Lambert PR, Meyer TA. Neuromodulation for Treatment of Tinnitus: A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2024; 170:1234-1245. [PMID: 38353342 DOI: 10.1002/ohn.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 04/30/2024]
Abstract
OBJECTIVE To evaluate the treatment efficacy of neuromodulation versus sham for the treatment of tinnitus. DATA SOURCES Cochrane Library, CINAHL, PubMed, Scopus. REVIEW METHODS The Cochrane Library, CINAHL, PubMed, and Scopus were searched from inception through May 2023 for English language articles documenting "neuromodulation" and "tinnitus" stratified by sham-controlled randomized control trials with 40 or more patients. Data collected included Beck Anxiety Inventory, Beck Depression Inventory (BDI), Tinnitus Handicap Inventory (THI), Tinnitus Questionnaire, and Visual Analog Scale. A Meta-analysis of continuous measures (mean) and proportions (%) were conducted. RESULTS A total of 19 randomized control trials (N = 1186) were included. The mean age was 48.4 ± 5.3 (range: 19-74), mean duration of tinnitus was 3.8 ± 3.4 years, 61% [56.2-65.7] male, and 55.7% [46-65] with unilateral tinnitus. The short-term effect of transcutaneous electrical nerve stimulation and transcranial direct current stimulation on THI score is -16.2 [-23.1 to -9.3] and -19 [-30.1 to -7.8], respectively. The long-term effect of repetitive transcranial magnetic stimulation on THI score is -8.6 [-11.5 to -5.7]. Transcranial direct current stimulation decreases BDI score by -11.8 [-13.3 to -10.3]. CONCLUSION As measured by the Tinnitus Handicap Index, our findings suggest the effects of transcutaneous electrical nerve stimulation and transcranial direct current stimulation reach significant benefit in the short term, whereas repetitive transcranial magnetic stimulation reaches significant benefit in the long term. Based on the BDI, transcranial direct current stimulation significantly reduces comorbid depression in patients with tinnitus.
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Affiliation(s)
- Luke D Heiland
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Johnny M Owen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Robert F Labadie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul R Lambert
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ted A Meyer
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Karaca O, Kılınç M. Sensory training combined with motor training improves trunk proprioception in stroke patients: a single-blinded randomized controlled trial. Neurol Res 2024:1-8. [PMID: 38565199 DOI: 10.1080/01616412.2024.2337522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Inadequate trunk function is the underlying cause of many problems such as impaired balance and mobility. Although there have been trunk-based physiotherapy approaches in recent years, almost all of these approaches focus on motor problems. This study aims to investigate the effects of sensory training combined with trunk-centered Bobath exercises on trunk control and proprioception, balance, gait, and the activity of daily living (ADL). MATERIALS AND METHODS This study is a randomized controlled trial included with twenty-seven stroke patients. Participants were separated into two groups, Group 1; 'sensory training combined with trunk-centered Bobath exercises' and Group 2; 'trunk-centered Bobath exercises'. Trunk-centered Bobath exercises were used for motor training. Sensory training included transcutaneous electric nerve stimulation and a set of exercises that provide tactile and proprioceptive stimulation. Trunk Impairment Scale, Trunk Reposition Error, Berg Balance Scale, 2-minute walk test, and Barthel Index were used to assess trunk control, trunk proprioception, balance, gait, and ADL respectively. RESULTS Intra-group analysis results showed that trunk control, trunk proprioception, balance, gait, and ADL improved in both groups after treatment (p < 0.05). The changes in the Trunk Reposition Error values of the participants in Group 1 before and after treatment was found to be significantly higher than Group 2 (p < 0.05). CONCLUSIONS The findings indicated that the application of trunk-centered motor training is effective in improving trunk proprioception and trunk control, balance, gait, and ADL in stroke patients. Also, sensory training combined with trunk-centered motor training was found more effective in improving trunk proprioception than solely motor training.
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Affiliation(s)
- Osman Karaca
- Department of Physiotherapy and Rehabilitation, KTO Karatay University, Konya, Türkiye
| | - Muhammed Kılınç
- Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
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3
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Parodi S, Kendall HJ, Terrone C, Heesakkers JPFA. What Is in the Pipeline on Investigational Neuromodulation Techniques for Lower Urinary Tract Dysfunction: A Narrative Review. Neuromodulation 2024; 27:267-272. [PMID: 37865890 DOI: 10.1016/j.neurom.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/10/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES Overactive bladder (OAB) affects millions of patients worldwide. Its treatment is challenging but improves the patient's quality of life. Besides standard techniques for neuromodulation (sacral and pudendal neuromodulation and posterior tibial nerve stimulation), several new techniques have been investigated to treat symptoms of refractory OAB. The purpose of the present review is to outline the state of the art of new neuromodulation techniques for lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS In March 2023, a comprehensive MEDLINE, EMBASE, and Scopus search was carried out (keywords: LUTD, new technologies, neuromodulation, LUTS, OAB, painful bladder syndromes, etc). Articles were included according to inclusion (randomized controlled trials, prospective trials, large retrospective studies) and exclusion (case reports, outcomes not clearly expressed in full text, animal studies) criteria. The reference lists of the included studies also were scanned. Both adult and pediatric populations were included, in addition to both neurogenic and nonneurogenic OAB. A narrative review was then performed. RESULTS Peroneal neuromodulation, transcutaneous electrical nerve stimulation, magnetic nerve stimulation, and parasacral transcutaneous neuromodulation are the most studied investigative techniques and were shown to yield promising results in treating OAB symptoms. Most studies showed promising results even in the complex scenarios of patients with OAB refractory to standard treatments. Comparing investigational techniques with standard of care and their respective clinical outcomes and safety profiles, and confronting their pros and cons, we reasonably believe that once such treatment modalities are further developed, they could play a role in the OAB treatment algorithm. CONCLUSIONS Although the described neuromodulation techniques are being intensely studied, the available results are not yet sufficient for any guidelines to recommend their use.
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Affiliation(s)
- Stefano Parodi
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; University Medical Center, Maastricht, The Netherlands.
| | | | - Carlo Terrone
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Malakouti N, Serruya MD, Cramer SC, Kimberley TJ, Rosenwasser RH. Making Sense of Vagus Nerve Stimulation for Stroke. Stroke 2024; 55:519-522. [PMID: 38095119 DOI: 10.1161/strokeaha.123.044576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Implantable vagus nerve stimulation, paired with high-dose occupational therapy, has been shown to be effective in improving upper limb function among patients with stroke and received regulatory approval from the US Food and Drug Administration and the Centers for Medicare & Medicaid Services. Combining nonsurgical and surgical approaches of vagus nerve stimulation in recent meta-analyses has resulted in misleading reports on the efficacy of each type of stimulation among patients with stroke. This article aims to clarify the confusion surrounding implantable vagus nerve stimulation as a poststroke treatment option, highlighting the importance of distinguishing between transcutaneous auricular vagus nerve stimulation and implantable vagus nerve stimulation. Recent meta-analyses on vagus nerve stimulation have inappropriately combined studies of fundamentally different interventions, outcome measures, and participant selection, which do not conform to methodological best practices and, hence, cannot be used to deduce the relative efficacy of the different types of vagus nerve stimulation for stroke rehabilitation. Health care providers, patients, and insurers should rely on appropriately designed research to guide well-informed decisions.
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Affiliation(s)
- Niloufar Malakouti
- Raphael Center for Neurorestoration (N.M., M.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA
| | - Mijail D Serruya
- Raphael Center for Neurorestoration (N.M., M.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA
- Department of Neurology (M.D.S.), Thomas Jefferson University Hospital, Philadelphia, PA
| | - Steven C Cramer
- Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), California Rehabilitation Institute (S.C.C.)
| | - Teresa J Kimberley
- Department of Physical Therapy, School of Health and Rehabilitation Science, MGH Institute of Health Professions, Boston, MA (T.J.K.)
| | - Robert H Rosenwasser
- Department of Neurological Surgery (R.H.R.), Thomas Jefferson University Hospital, Philadelphia, PA
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Rego RMP, Machado NC, Carvalho MDA, Graffunder JS, Fraguas C, Ortolan EVP, Lourenção PLTDA. Transcutaneous Posterior Tibial Nerve Stimulation: An Adjuvant Treatment for Intractable Constipation in Children. Biomedicines 2024; 12:164. [PMID: 38255269 PMCID: PMC10813187 DOI: 10.3390/biomedicines12010164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Functional constipation can lead to painful defecations, fecal incontinence, and abdominal pain, significantly affecting a child's quality of life. Treatment options include non-pharmacological and pharmacological approaches, but some cases are intractable and require alternative interventions like neuromodulation. A subtype of neuromodulation, called Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS), comprises electrical stimulation at the ankle level, by means of electrodes fixed to the skin. TPTNS is a minimally invasive, easy-to-apply technique that can potentially improve constipation symptoms in the pediatric population by stimulating the sacral nerves. AIM To evaluate the clinical results and applicability of TPTNS as an adjuvant treatment for children and adolescents with functional constipation. METHODS Between April 2019 and October 2021, 36 patients diagnosed with functional constipation according to the Rome IV Criteria were invited to participate in the study. The study followed a single-center, uncontrolled, prospective cohort design. Patients received TPTNS for 4 or 8 weeks, with assessments conducted immediately after the periods of TPTNS and 4 weeks after the end of the intervention period. The data normality distribution was determined by the Shapiro-Wilk test. The Wilcoxon test and Student's t-test for paired samples were used to compare quantitative variables, and the McNemar test was used to compare categorical variables. RESULTS Of the 36 enrolled patients, 28 children and adolescents with intractable function constipation completed the study, receiving TPTNS for 4 weeks. Sixteen patients (57.1%) extended the intervention period for 4 extra weeks, receiving 8 weeks of intervention. TPTNS led to significant improvements in stool consistency, frequency of defecation, and bowel function scores, with a reduction in abdominal pain. Quality of life across physical and psychosocial domains showed substantial enhancements. The quality of life-related to bowel habits also improved significantly, particularly in lifestyle, behavior, and embarrassment domains. The positive effects of this intervention are seen relatively early, detected after 4 weeks of intervention, and even 4 weeks after the end of the intervention. TPTNS was well-tolerated, with an adherence rate of approximately 78%, and no adverse effects were reported. CONCLUSIONS TPTNS is an adjuvant treatment for intractable functional constipation, improving bowel function and quality of life. The effects of TPTNS were observed relatively early and sustained even after treatment cessation.
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Affiliation(s)
- Rebeca Mayara Padilha Rego
- Department of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (R.M.P.R.); (E.V.P.O.)
| | - Nilton Carlos Machado
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (N.C.M.); (M.d.A.C.)
| | - Mary de Assis Carvalho
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (N.C.M.); (M.d.A.C.)
| | - Johann Souza Graffunder
- Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil;
| | | | - Erika Veruska Paiva Ortolan
- Department of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (R.M.P.R.); (E.V.P.O.)
| | - Pedro Luiz Toledo de Arruda Lourenção
- Department of Surgery and Orthopedics, Division of Pediatric Surgery, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, SP, Brazil; (R.M.P.R.); (E.V.P.O.)
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Tavares Oliveira M, Maciel Santos M, Lucas Mayara da Cruz Reis K, Resende Oliveira L, DeSantana JM. Transcutaneous Electric Nerve Stimulation in Animal Model Studies: From Neural Mechanisms to Biological Effects for Analgesia. Neuromodulation 2024; 27:13-21. [PMID: 37115123 DOI: 10.1016/j.neurom.2023.02.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE This systematic and meta-analysis review evaluated the transcutaneous electrical nerve stimulation (TENS)-induced action mechanisms for animal analgesia. MATERIALS AND METHODS Two independent investigators identified relevant articles published until February 2021 through a literature review, and a random-effects meta-analysis was performed to synthesize the results. RESULTS Of the 6984 studies found in the data base search, 53 full-text articles were selected and used in the systematic review. Most studies used Sprague Dawley rats (66.03%). High-frequency TENS was applied to at least one group in 47 studies, and most applications were performed for 20 minutes (64.15%). Mechanical hyperalgesia was analyzed as the primary outcome in 52.83% of the studies and thermal hyperalgesia in 23.07% of studies using a heated surface. More than 50% of the studies showed a low risk of bias on allocation concealment, random housing, selective outcome reporting, and acclimatization before the behavioral tests. Blinding was not performed in only one study and random outcome assessment in another study; acclimatization before the behavioral tests was not performed in just one study. Many studies had an uncertain risk of bias. Meta-analyses indicated no difference between low-frequency and high-frequency TENS with variations among the pain models. CONCLUSIONS This systematic review and meta-analysis suggests that TENS has presented a substantial scientific foundation for its hypoalgesic effect in preclinical studies for analgesia.
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Affiliation(s)
| | - Mateus Maciel Santos
- Department of Physical Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Larissa Resende Oliveira
- Graduate Program in Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Josimari Melo DeSantana
- Graduate Program in Health Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Department of Physical Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Graduate Program in Physiological Science, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
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R Velingkar K, Ramachandra P, V Pai M, Krishna Rao B. Influence of transcutaneous electrical nerve stimulation on pain intensity and functional activities following lower segment cesarean section. Physiother Theory Pract 2023; 39:2099-2105. [PMID: 35481415 DOI: 10.1080/09593985.2022.2070089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 04/15/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Postoperative incisional pain following lower segment cesarean section (LSCS) is one of the commonly reported complaints which may affect mother-infant bonding, and restrict mobility and functional activities. PURPOSE To study the influence of transcutaneous electrical nerve stimulation (TENS) on pain intensity and functional activities using the Numerical Pain Rating Scale (NPRS) and the Patient Specific Functional Scale (PSFS) following LSCS from the postoperative day (POD) 1 to POD 4. METHODS This quasi-experimental study consisted of 50 postpartum women who underwent LSCS and were assigned to an intervention group (IG) that received TENS and a control group (CG) that received routine hospital care. RESULTS NPRS scores between CG and IG (pre-TENS application) showed a statistically significant difference (ηp2 = 0.542, p < .001) from POD 1 to POD 4. Study participants showed an improvement in PSFS scores (ηp2 = 0.412, 0.488, 0.661, 0.304, 0.262, and 0.395, p < .001) in IG compared to CG for bed transitions, bed transfers, sitting, sit to stand, walking, and toileting activities respectively from POD 1 to POD 4 which was statistically significant. CONCLUSIONS Our study results suggest that administration of TENS following LSCS shows an improvement in pain intensity and functional activities as reported on NPRS and PSFS respectively.
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Affiliation(s)
- Kiransha R Velingkar
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Preetha Ramachandra
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Muralidhar V Pai
- Department of Obstetrics and Gynecology, Sikkim Manipal Institute of Medical Sciences, Gangtok, India
| | - Bhamini Krishna Rao
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
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Tugay M, Kul A. Efficacy of Interferential Current Therapy in Patients Diagnosed with Subacromial Impingement Syndrome. Eurasian J Med 2023; 55:192-198. [PMID: 37909189 PMCID: PMC10724834 DOI: 10.5152/eurasianjmed.2023.22282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/13/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE The objective of the study was to evaluate the effectiveness of interferential current treatment on a range of motion of joint and shoulder pain, functional status, and quality of life in patients with subacromial impingement syndrome and to compare interferential current with transcutaneous electrical nerve stimulation and sham interferential current. MATERIALS AND METHODS Patients complaining of shoulder discomfort participated in the present study. Diagnosis of subacromial impingement syndrome is based on anamnesis, clinical examinations, and shoulder magnetic resonance imaging. A total of 52 patients divided into 3 groups: Group 1 (17 patients, mean age 51.8 years) received interferential current, group 2 (18 patients, mean age 51.8 years) received transcutaneous electrical nerve stimulation, and group 3 (17 patients, mean age 49.1 years) received sham interferential current. Hot pack and exercise treatments were added to all groups. All groups were treated for 3 weeks, 5 times a week, for 15 sessions and 20 minutes for each session. Evaluations were made before treatment (T0), in the middle of treatment (T1; end of 8th session), and at the end of treatment (T2; end of 15th session) using active range of motion and visual analog scale for pain, the Arm, Shoulder, and Hand Problems Questionnaire for functional status, and Short Form-36 for quality of life. RESULTS There were significant improvement effects on all of the range of motion, visual analog scale, and the Arm, Shoulder, and Hand Problems Questionnaire scores at T2 and on the scores in some subparameters of Short Form-36 in all groups (P < .05). However, there was no statistically significant difference at T2 between the groups (P > .05). CONCLUSION Interferential current and transcutaneous electrical nerve stimulation exhibited equivalent results regarding range of motion, pain, function, and quality of life of patients with subacromial impingement syndrome, with no significant difference between interferential current and transcutaneous electrical nerve stimulation. Adding interferential current or transcutaneous electrical nerve stimulation treatments to hot pack +exercise therapy did not result in any extra benefits to the patients.
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Affiliation(s)
- Muhammet Tugay
- Deparment of Physical Medicine and Rehabilitation, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Ayhan Kul
- Deparment of Physical Medicine and Rehabilitation, Atatürk University Faculty of Medicine, Erzurum, Turkey
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Shahdad A, Fadaee Aghdam N, Goli S, Binesh E, Nourian J, Khajeh M. Effect of transcutaneous electrical nerve stimulation of acupoints on respiratory outcomes of COVID-19 patients with moderate pulmonary involvement: A parallel randomized clinical trial. Health Sci Rep 2023; 6:e1427. [PMID: 37492271 PMCID: PMC10363792 DOI: 10.1002/hsr2.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
Background and aims Experiencing respiratory symptoms, especially dyspnea and decreased oxygen saturation (SpO2) level in patients with coronavirus disease 2019 (COVID-19) is associated with increased mortality. The present study was conducted to investigate the effect of transcutaneous electrical nerve stimulation of acupoints (Acu-TENS) on the respiratory outcomes of COVID-19 patients with moderate pulmonary involvement. Methods In these three-blind parallel randomized clinical trials, 84 patients with COVID-19 admitted to a referral hospital were selected by the convenience sampling method. Participants were randomly assigned to Acu-TENS (n = 42) and control (n = 42) groups. The Acu-TENS group received Acu-TENS over the EX-B1 (Dingchuan) acupuncture point for 45 min for four consecutive days, while participants in the control group received no intervention. Participants' respiratory outcomes, including oxygen saturation, vital signs, and the severity of dyspnea, were evaluated before and after each intervention on four consecutive days. In addition, the need for mechanical ventilation on Days 4, 8, and 12 and the disease's outcome (death or survival) were recorded in SPSS software version 16, and finally, data were analyzed using an independent samples t-test. Results SpO2, the number of patients without the need for mechanical ventilation, and patient survival after the intervention were significantly higher in the Acu-TENS group compared with the control group (<0.001). However, respiratory rate, heart rate, and the severity of dyspnea after the intervention were not significantly different between the two groups (p > 0.05). Conclusion The use of Acu-TENS could improve SpO2 as a respiratory outcome of patients with COVID-19 with moderate pulmonary involvement and it can be used as a therapeutic intervention.
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Affiliation(s)
- Amin Shahdad
- Student Research Committee, Nursing and Midwifery SchoolShahroud University of Medical SciencesShahroudIran
| | - Nasrin Fadaee Aghdam
- Department of Nursing, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
| | - Shahrbanoo Goli
- Department of Epidemiology, School of Public HealthShahroud University of Medical SciencesShahroudIran
| | - Ehsan Binesh
- Clinical Research Development Unit, Imam Hossein HospitalShahroud University of Medical SciencesShahroudIran
| | - Javad Nourian
- Clinical Research Development Unit, Imam Hossein HospitalShahroud University of Medical SciencesShahroudIran
| | - Mahboobeh Khajeh
- Department of Nursing, School of Nursing and MidwiferyShahroud University of Medical SciencesShahroudIran
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Abstract
Neurotechnologies for treating pain rely on electrical stimulation of the central or peripheral nervous system to disrupt or block pain signaling and have been commercialized to treat a variety of pain conditions. While their adoption is accelerating, neurotechnologies are still frequently viewed as a last resort, after many other treatment options have been explored. We review the pain conditions commonly treated with electrical stimulation, as well as the specific neurotechnologies used for treating those conditions. We identify barriers to adoption, including a limited understanding of mechanisms of action, inconsistent efficacy across patients, and challenges related to selectivity of stimulation and off-target side effects. We describe design improvements that have recently been implemented, as well as some cutting-edge technologies that may address the limitations of existing neurotechnologies. Addressing these challenges will accelerate adoption and change neurotechnologies from last-line to first-line treatments for people living with chronic pain.
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Affiliation(s)
- Lee E Fisher
- Rehab Neural Engineering Labs, Department of Physical Medicine and Rehabilitation, and Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Scott F Lempka
- Department of Biomedical Engineering, Biointerfaces Institute, and Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA;
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Wang C, Wang P, Qi G. A new use of transcutaneous electrical nerve stimulation: Role of bioelectric technology in resistant hypertension (Review). Biomed Rep 2023; 18:38. [PMID: 37168651 PMCID: PMC10165504 DOI: 10.3892/br.2023.1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/21/2023] [Indexed: 05/13/2023] Open
Abstract
Hypertension is an important risk factor for cardiovascular and cerebrovascular disease-associated death. Hypertension and its complications are the main problems that have an impact on public health at present. A portion of adults with hypertension fail to meet the recommended blood pressure (BP) treatment goals, despite strict clinical management. Those individuals requiring at least three types of antihypertensive drugs to achieve their BP goal may be classified as patients with resistant hypertension (RH). Bioelectric technology is an emerging method that functions with the help of the human body's own bioelectric system. It is widely used in auxiliary examination, pain relief and organ function rehabilitation. Bioelectrical technology, as an effective treatment for RH, has developed rapidly in recent years and mainly includes renal sympathetic denervation, carotid baroreflex activation therapy, Traditional Chinese Medicine electroacupuncture and transcutaneous electrical nerve stimulation (TENS). The present review describes the pathogenesis of hypertension and provides an understanding of bioelectrical technology as a treatment. In particular, the development of the application of TENS in RH is introduced. The aim is to provide a basis for the clinical treatment of RH and a new idea for further clinical trials in this field.
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Affiliation(s)
- Chenghua Wang
- The Third Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050030, P.R. China
| | - Pu Wang
- The Third Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050030, P.R. China
| | - Guoqing Qi
- The Third Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei 050030, P.R. China
- Correspondence to: Dr Guoqing Qi, The Third Department of Cardiology, The First Hospital of Hebei Medical University, 89 Donggang Road, Shijiazhuang, Hebei 050030, P.R. China
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Oliveira LF, Silva LID, Franck HHM, Guimarães KG, Cardoso JSS, Ribeiro ACP, Figueiredo AA, Silva SADASE, de Bessa J, Netto JMB. Parasacral transcutaneous electrical neural stimulation versus urotherapy in primary monosymptomatic enuresis: A prospective randomized clinical trial. Neurourol Urodyn 2023. [PMID: 37232538 DOI: 10.1002/nau.25207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the clinical response of parasacral transcutaneous electrical neural stimulation (parasacral TENS) associated with urotherapy in children with primary monosymptomatic nocturnal enuresis (PMNE) compared to urotherapy alone. MATERIAL AND METHODS This prospective controlled clinical trial enrolled 72 children over 5 years of age with PMNE. Children were randomly divided into two groups, control group (CG), treated with urotherapy and scapular stimulation, and experimental group (EG), treated with urotherapy and parasacral TENS. In both groups, 20 sessions were performed, 3 times weekly, for 20 min each, with 10 Hz frequency, 700 μS pulse width and intesity determinated by the patient threshold. The percentages of dry nights were analyzed for 14 days before treatment (T0), after the 20th session (T1), 15 (T2), 30 (T3), 60 (T4), and 90 (T5) days after the end of the sessions. Patients of both groups were followed with intervals of 2 weeks in the first month and monthly for three consecutive months. RESULTS Twenty-eight enuretic children, 14 girls (50%) with a mean age of 9.09 ± 2.23 years completed the study. There was no difference in mean age between groups. Mean percentage of dry nights in EG at T0 was 36%, at T1 49%, at T2 54%, at T3 54%, at T4 54%, and 57% at T5; while in CG, these percentages were 28%, 39%, 37%, 35%, 36%, and 36%, respectively. CONCLUSIONS Parasacral TENS associated with urotherapy improves the percentage of dry nights in children with PMNE, although no patient had complete resolution of symptoms in this study.
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Affiliation(s)
- Liliana Fajardo Oliveira
- School of Physiotherapy-Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ/SUPREMA), Juiz de Fora, Brazil
| | - Lidyanne Ilidia da Silva
- Department of Surgery, School of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Hanny Helena Masson Franck
- Department of Surgery, School of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | | | | | - André Costa Pinto Ribeiro
- Department of Surgery, Division of Otolaryngology, Universidade Estadual de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - André A Figueiredo
- Department of Surgery, School of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | | | - José de Bessa
- Department of Surgery, School of Medicine, Universidade Estadual de Feira de Santana (UEFS), Juiz de Fora, Brazil
| | - José Murillo B Netto
- Department of Surgery, School of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
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Krhut J, Rejchrt M, Slovak M, Dvorak RV, Peter L, Blok BFM, Zvara P. Prospective, Randomized, Multicenter Trial of Peroneal Electrical Transcutaneous Neuromodulation vs Solifenacin in Treatment-naïve Patients With Overactive Bladder. J Urol 2023; 209:734-741. [PMID: 36579932 DOI: 10.1097/ju.0000000000003141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE We investigated the safety and efficacy of peroneal electrical transcutaneous neuromodulation using the URIS neuromodulation system in a home-based setting in comparison with standard treatment using solifenacin in treatment-naïve female patients with overactive bladder. MATERIALS AND METHODS A total of 120 patients were screened, of whom 77 were randomized in a 2:1 ratio to 12 weeks of treatment with daily peroneal electrical transcutaneous neuromodulation or solifenacin 5 mg. The primary endpoint was safety; efficacy assessments included proportion of responders, defined as subjects with ≥50% reduction in bladder diary-derived variables; Overactive Bladder-Validated 8-question Screener, and European Quality of Life-5 Dimensions questionnaire; and treatment satisfaction after 12 weeks of therapy. RESULTS Seventy-one out of 77 randomized patients completed the study. In the peroneal electrical transcutaneous neuromodulation group 6/51 (12%) patients reported a treatment-related adverse event vs 12/25 (48%) in the solifenacin group (P < .001). No clinically significant changes were observed in any other safety endpoint. The proportions of responders in the peroneal electrical transcutaneous neuromodulation group vs the solifenacin group were 87% vs 74% with respect to Patient Perception of Intensity of Urgency Scale grade 3 urgency episodes, 87% vs 75% with respect to grade 3+4 urgency episodes, and 90% vs 94% with respect to urgency incontinence episodes. In post hoc analyses we observed significant improvement over time in multiple efficacy variables in both treatment arms. CONCLUSIONS Peroneal electrical transcutaneous neuromodulation is a safe and effective method for overactive bladder treatment associated with a significantly lower incidence of treatment-related adverse events compared to solifenacin and a considerably better benefit-risk profile.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Ostrava, Czech Republic
- Department of Surgical Studies, Faculty of Medicine, Ostrava University, Ostrava, Czech Republic
| | - Michal Rejchrt
- Department of Urology, 2nd Faculty of Medicine of Charles University and Motol University Hospital, Prague, Czech Republic
| | | | | | - Lukas Peter
- StimVia, Ostrava, Czech Republic
- Department of Chemistry, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter Zvara
- Biomedical Laboratory and Research Unit of Urology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Odense University Hospital, Odense, Denmark
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14
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Iverson AM, Arbuckle AL, Ueda K, Song DY, Bihun EC, Koller JM, Wallendorf M, Black KJ. Median Nerve Stimulation for Treatment of Tics: Randomized, Controlled, Crossover Trial. J Clin Med 2023; 12:2514. [PMID: 37048598 PMCID: PMC10095326 DOI: 10.3390/jcm12072514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MNS) entrained the sensorimotor cortex EEG signal and found that 10 Hz MNS improved tics in Tourette syndrome (TS). However, no control condition was tested, and stimulation blocks lasted only 1 min. We set out to replicate the TS results and to test whether tic improvement occurs by the proposed cortical entrainment mechanism. Preregistration was completed at ClinicalTrials.gov, under number NCT04731714. Thirty-two people with TS, age 15-64, completed two study visits with repeated MNS on and off blocks in random order, one visit for rhythmic and one for arrhythmic MNS. Subjects and staff were blind to order; a video rater was additionally blind to stimulation and to the order of visits and blocks. Rhythmic MNS at 10 Hz improved tics. Both rhythmic and arrhythmic 12 Hz MNS improved tic frequency, intensity, and urges, but the two treatments did not differ significantly. Participant masking was effective, and there was no carryover effect. Several participants described a dramatic benefit. Discomfort was minimal. There was no evidence that the MNS benefit persisted after stimulation ended. These results replicate the tic benefit from MNS but show that the EEG entrainment hypothesis cannot explain that benefit. Another electrophysiological mechanism may explain the benefit; alternatively, these data do not exclude a placebo effect.
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Affiliation(s)
- Ann M. Iverson
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Amanda L. Arbuckle
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Keisuke Ueda
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - David Y. Song
- University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Emily C. Bihun
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Jonathan M. Koller
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Michael Wallendorf
- Division of Biostatistics, Institute for Informatics, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology, and Neuroscience, Washington University in St. Louis, St. Louis, MO 63110, USA
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15
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Zillioux J, Lewis KC, Hettel D, Goldman HB, Vasavada SP, Gill BC. Cognitive impairment does not impact sacral neuromodulation implant rates for overactive bladder. Neurourol Urodyn 2023; 42:623-630. [PMID: 36701189 DOI: 10.1002/nau.25138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate the impact of cognitive impairment (CI) diagnoses on sacral neuromodulation (SNM) outcomes in older patients. MATERIALS AND METHODS We completed a retrospective review of all patients aged ≥55 years who underwent test-phase SNM (peripheral nerve evaluation (PNE) or stage 1) for overactive bladder (OAB) between 2014 and 2021 within a large multi-regional health system. Patient demographics, relevant comorbidities, CI diagnoses (dementia or mild CI), and SNM procedures were recorded. Logistic regression modeling was performed to evaluate the impact of CI on SNM implantation rates. RESULTS Five-hundred and ten patients underwent SNM test phase (161 PNE, 349 Stage 1) during the study period. The mean age was 71.0(8.5) years, and most (80.6%) were female. Overall, 52(10.1%) patients had a CI diagnosis at the time of SNM, and 30 (5.8%) were diagnosed at a median of 18.5 [9.25, 39.5] months after SNM. Patients with CI diagnoses were older, with more comorbidities, and were more likely to undergo PNE. Univariable comparison found no difference in implantation rate based on pre-SNM CI (85.4% vs. 76.9%, p = 0.16). Multivariable analysis identified PNE (OR 0.43, 95% CI 0.26-0.71), age (OR 0.96, 95%CI 0.93-0.98), and prior beta-3 agonist use (OR 0.60, 95% CI 0.37-0.99) but not CI or dementia as independent negative predictors of implantation. Implanted patients had a median follow-up of 25 [12.0, 55.0] months. Explant and revision rates did not differ according to CI. CONCLUSION Patients with OAB and CI diagnoses proceed to SNM implant at rates similar to patients without CI diagnoses. A diagnosis of CI should not necessarily exclude patients from SNM therapy for refractory OAB.
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Affiliation(s)
- Jacqueline Zillioux
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin C Lewis
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Hettel
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Howard B Goldman
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Sandip P Vasavada
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Bradley C Gill
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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16
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Iverson AM, Arbuckle AL, Ueda K, Song DY, Bihun EC, Koller JM, Wallendorf M, Black KJ. Peripheral nerve induction of inhibitory brain circuits to treat Tourette syndrome: A randomized crossover trial. medRxiv 2023:2023.02.01.23285304. [PMID: 36778375 PMCID: PMC9915823 DOI: 10.1101/2023.02.01.23285304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A prior study showed that rhythmic, but not arrhythmic, 12 Hz stimulation of the median nerve (MNS) entrained sensorimotor cortex EEG signal, and found that 10 Hz MNS improved tics in Tourette syndrome (TS). However, no control condition was tested and stimulation blocks lasted only 1 minute. We set out to replicate the TS results and to test whether tic improvement occurs by the proposed cortical entrainment mechanism. Thirty-two people with TS, age 15-64, completed two study visits with repeated MNS on and off blocks in random order, one visit for rhythmic and one for arrhythmic MNS. Subjects and staff were blind to order; a video rater was additionally blind to stimulation and to order of visits and blocks. Rhythmic MNS at 10 Hz improved tics. Both rhythmic and arrhythmic 12 Hz MNS improved tic frequency, intensity and urges without significant difference. Participant masking was effective and there was no carryover effect. Several participants described dramatic benefit. Discomfort was minimal. MNS benefit did not persist after the end of stimulation. These results replicate the tic benefit from MNS, but show that the EEG entrainment hypothesis cannot explain that benefit. Another electrophysiological mechanism may explain benefit; alternatively, these data do not exclude a placebo effect. Registration ClinicalTrials.gov , NCT04731714 .
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17
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Tamartash H, Bahrpeyma F, Dizaji MM. The effect of transcutaneous electrical nerve stimulation on pain and electrical stimulation muscle thickness in patients with non-specific chronic low back pain-based ultrasonographic evaluation. Pain Manag 2023; 13:87-94. [PMID: 36621774 DOI: 10.2217/pmt-2022-0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Aim: The existing mechanisms of transcutaneous electrical nerve stimulation (TENS) focuses more on the effect of neural tissue. This study investigated the effect of TENS on the thickness of the erector spinae muscles and reducing pain. Patients & methods: 56 individuals with low back pain participated in this single-blind, pre/post-test study. For 2 weeks, participants underwent ten sessions of TENS. The ultrasound evaluations examined the thickness of the erector spinae muscle, and the visual analog scale measured the severity of low back pain. Results: There was a decrease in pain score and muscle thickness after the interventions (p ≤ 0.004). There was also a strong correlation between reducing pain and decreasing muscle thickness (R = 0.709; p = 0.000). Conclusion: Following TENS in the lumbar, in addition to reducing pain, the thickness of the erector spinae muscles also decreased. Clinical Trial Registration: IRCT20200423047173N1 (ClinicalTrials.gov).
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Affiliation(s)
- Hassan Tamartash
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Farid Bahrpeyma
- Department of Physiotherapy, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Manijhe Mokhtari Dizaji
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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18
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de Castro-Carletti EM, Müggenborg F, Dennett L, Sobral de Oliveira-Souza AI, Mohamad N, Pertille A, Rodrigues-Bigaton D, Armijo-Olivo S. Effectiveness of electrotherapy for the treatment of orofacial pain: A systematic review and meta-analysis. Clin Rehabil 2023; 37:891-926. [PMID: 36594219 DOI: 10.1177/02692155221149350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Summarize the evidence from randomized controlled trials and controlled trials that examined the effectiveness of electrotherapy in the treatment of patients with orofacial pain. DATA SOURCE Medline, Embase, CINAHL PLUS with Full text, Cochrane Library Trials, Web of Science, and Scopus. REVIEW METHODS A data search (last update, July 1, 2022) and a manual search were performed (October 5, 2022). Trials involving adults with orofacial pain receiving electrotherapy compared with any other type of treatment were included. The main outcome was pain intensity; secondary outcomes were mouth opening and tenderness. The reporting was based on the new PRISMA Guidelines. RESULTS From the electronics databases and manual search 43 studies were included. Although this study was open to including any type of orofacial pain, only studies that investigated temporomandibular disorders were found. The overall quality of the evidence for pain intensity was very low. Although the results should be carefully used, transcutaneous electric nerve stimulation therapy showed to be clinically superior to placebo for reducing pain after treatment (2.63 [-0.48; 5.74]) and at follow-up (0.96 [-0.02; 1.95]) and reduce tenderness after treatment (1.99 [-0.33; 4.32]) and at follow-up (2.43 [-0.24; 5.10]) in subjects with mixed temporomandibular disorders. CONCLUSION The results of this systematic review support the use of transcutaneous electric nerve stimulation therapy for patients with mixed temporomandibular disorders to improve pain intensity, and tenderness demonstrating that transcutaneous electric nerve stimulation is superior to placebo. There is inconsistent evidence supporting the superiority of transcutaneous electric nerve stimulation against other therapies.
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Affiliation(s)
- Ester Moreira de Castro-Carletti
- Post Graduate Program in Human Movement Sciences, Methodist University of Piracicaba - UNIMEP - Piracicaba (SP), Brazil.,Faculty of Business and Social Sciences, Hochschule Osnabrück-University of Applied Sciences, Osnabrück, Germany
| | - Frauke Müggenborg
- Faculty of Business and Social Sciences, Hochschule Osnabrück-University of Applied Sciences, Osnabrück, Germany
| | - Liz Dennett
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, Rehabilitation Research Center, 3158University of Alberta, Edmonton, Alberta, Canada
| | - Ana Izabela Sobral de Oliveira-Souza
- Faculty of Business and Social Sciences, Hochschule Osnabrück-University of Applied Sciences, Osnabrück, Germany.,Graduate Program in Neuropsychiatry and Behavioral Sciences, 28116Federal University of Pernambuco, Pernambuco, Brazil
| | - Norazlin Mohamad
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, Rehabilitation Research Center, 3158University of Alberta, Edmonton, Alberta, Canada.,Faculty of Health Sciences, Centre of Physiotherapy, Universiti Teknologi MARA, Puncak Alam Campus, Malaysia
| | - Adriana Pertille
- Post Graduate Program in Human Movement Sciences, Methodist University of Piracicaba - UNIMEP - Piracicaba (SP), Brazil
| | - Delaine Rodrigues-Bigaton
- Post Graduate Program in Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas - UNICAMP - Piracicaba (SP), Brazil
| | - Susan Armijo-Olivo
- Faculty of Business and Social Sciences, Hochschule Osnabrück-University of Applied Sciences, Osnabrück, Germany.,Faculty of Rehabilitation Medicine, Department of Physical Therapy, Rehabilitation Research Center, 3158University of Alberta, Edmonton, Alberta, Canada.,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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19
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Zeng W, Lou H, Huang Q, Li K, Liu X, Wu K. Eliciting blinks by transcutaneous electric nerve stimulation improves tear fluid in healthy video display terminal users: A self-controlled study. Medicine (Baltimore) 2022; 101:e31352. [PMID: 36343050 PMCID: PMC9646660 DOI: 10.1097/md.0000000000031352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We aimed to elicit strong blinks among healthy video display terminal (VDT) users by periorbital transcutaneous electric nerve stimulation (TENS) and evaluate its impact on the tear fluid and visual task. Appropriate TENS conditions were evaluated to evoke strong blinks under minimum discomfort. Seventeen healthy VDT users with noninvasive Keratograph first breakup time (NIKf-BUT) 5-15 s and Ocular Surface Disease Index (OSDI) scores < 15 were recruited in this study. Before the trial, noninvasive Keratograph average breakup time (NIKa-BUT), tear meniscus height (TMH) and OSDI scores were evaluated. Before each TENS session, the volunteers played Tetris while the corresponding blink rate and Tetris scores were recorded. Then, the participants underwent 30 minutes of TENS, which evoked blinking of their right eye 20 times per minute. Tetris scores were evaluated again during TENS. The Tetris scores and corresponding blink rate were assessed after each TENS session while NIKa-BUT, TMH and OSDI scores were recorded after the third and sixth TENS sessions. We found that OSDI scores declined significantly after the sixth TENS (P = .003). The NIKa-BUT of the right eye was promoted after the sixth TENS (P = .02), and the TMH was higher after the third and sixth TENS in both eyes (P = .03, P = .03 for right eyes respectively, P = .01, P = .01 for left eyes respectively). There was no significant difference between the adjusted Tetris scores before and during TENS (P = .12). The blink rate before and after TENS were unaffected after 6 sessions (P = .61). The results indicated that periorbital TENS effectively ameliorated ocular irritation and improved tear secretion and tear film stability by eliciting strong blinks in healthy VDT users without disturbing the visual task.
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Affiliation(s)
- Weiting Zeng
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Han Lou
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Quanbin Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Kunke Li
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiuping Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Kaili Wu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- * Correspondence: Kaili Wu, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China (e-mail: )
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Senin-Camargo F, Martínez-Rodríguez A, Chouza-Insua M, Raposo-Vidal I, Jácome MA. Effects on venous flow of transcutaneous electrical stimulation, neuromuscular stimulation, and sham stimulation on soleus muscle: A randomized crossover study in healthy subjects. Medicine (Baltimore) 2022; 101:e30121. [PMID: 36107611 PMCID: PMC9439730 DOI: 10.1097/md.0000000000030121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Activation of venous flow has been shown with different types of electrical stimulation. The aim of this study is to compare the hemodynamic effects of transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), and sham stimulation on healthy young people. METHODS This randomized crossover study was conducted during June 2018 in the Faculty of Physical Therapy of A Coruña (Spain). Twenty-four university students (50% male) received in a randomized order 5 Hz-TENS, NMES, and sham stimulation on soleus muscle. Flow volume (FV) and peak velocity (PV) from popliteal vein were recorded via Doppler ultrasound, and relative changes from baseline were determined. Discomfort among the 3 stimulations was also compared. RESULTS The differences among the 3 stimulations were assessed using the ANOVA for repeated measured, the Friedman test and the Kendall tau test, according to the type of measurement to be compared. FV (mL/min) and PV (cm/s) increased significantly after NMES (percentual increase 37.2 ± 62.0%, P = .002; 264.4 ± 152.2%, P < .001, respectively) and TENS (226.2 ± 190.3%, P < .001; 202.7 ± 144.6%, P < .001, respectively). These percentual changes from basal level in hemodynamics were statistically different to those after placebo, which was ineffective enhancing hemodynamics. The improvements in FV were statistically higher with TENS than with NMES (P < .001), but there was no statistical difference in PV (P = .531). Despite NMES was applied at a significantly lower amplitude than TENS (P < .001), NMES protocol was the worst tolerated, though the differences in discomfort were not statistically significant. CONCLUSION Both active electrical protocols but not sham stimulation increased hemodynamics in healthy people. TENS obtained higher flow volume increase from baseline than NMES, considered globally at not only in its on-time.
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Affiliation(s)
- Francisco Senin-Camargo
- Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, A Coruña, Spain
| | - Alicia Martínez-Rodríguez
- Psychosocial Intervention and Functional Rehabilitation Research Group, Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, A Coruña, Spain
| | - Marcelo Chouza-Insua
- NEUROcom Group, Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, A Coruña, Spain
- *Correspondence: Marcelo Chouza-Insua, NEUROcom Group, Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, Campus de Oza, 15006, A Coruña, Spain (e-mail: )
| | - Isabel Raposo-Vidal
- Psychosocial Intervention and Functional Rehabilitation Research Group, Department of Physical Therapy, Medicine and Biomedical Sciences, Universidade da Coruña, A Coruña, Spain
| | - M. Amalia Jácome
- MODES Group, CITIC, Department of Mathematics, Faculty of Sciences, Universidade da Coruña, A Coruña, Spain
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21
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Whittier TT, Weller ZD, Fling BW. I Can Step Clearly Now, the TENS Is On: Transcutaneous Electric Nerve Stimulation Decreases Sensorimotor Uncertainty during Stepping Movements. Sensors (Basel) 2022; 22:s22145442. [PMID: 35891122 PMCID: PMC9317326 DOI: 10.3390/s22145442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 06/01/2023]
Abstract
Transcutaneous electric nerve stimulation (TENS) is a method of electrical stimulation that elicits activity in sensory nerves and leads to improvements in the clinical metrics of mobility. However, the underlying perceptual mechanisms leading to this improvement are unknown. The aim of this study was to apply a Bayesian inference model to understand how TENS impacts sensorimotor uncertainty during full body stepping movements. Thirty healthy adults visited the lab on two occasions and completed a motor learning protocol in virtual reality (VR) on both visits. Participants were randomly assigned to one of three groups: TENS on first visit only (TN), TENS on second visit only (NT), or a control group where TENS was not applied on either visit (NN). Using methods of Bayesian inference, we calculated the amount of uncertainty in the participants' center of mass (CoM) position estimates on each visit. We found that groups TN and NT decreased the amount of uncertainty in the CoM position estimates in their second visit while group NN showed no difference. The least amount of uncertainty was seen in the TN group. These results suggest that TENS reduces the amount of uncertainty in sensory information, which may be a cause for the observed benefits with TENS.
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Affiliation(s)
- Tyler T. Whittier
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA;
| | - Zachary D. Weller
- Department of Statistics, Colorado State University, Fort Collins, CO 80523, USA;
| | - Brett W. Fling
- Sensorimotor Neuroimaging Laboratory, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO 80523, USA;
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, CO 80523, USA
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França C, Carra RB, Diniz JM, Munhoz RP, Cury RG. Deep brain stimulation in Parkinson's disease: state of the art and future perspectives. Arq Neuropsiquiatr 2022; 80:105-115. [PMID: 35976323 PMCID: PMC9491408 DOI: 10.1590/0004-282x-anp-2022-s133] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/29/2022] [Indexed: 05/14/2023]
Abstract
For more than 30 years, Deep Brain Stimulation (DBS) has been a therapeutic option for Parkinson's disease (PD) treatment. However, this therapy is still underutilized mainly due to misinformation regarding risks and clinical outcomes. DBS can ameliorate several motor and non-motor symptoms, improving patients' quality of life. Furthermore, most of the improvement after DBS is long-lasting and present even in advanced PD. Adequate patient selection, precise electric leads placement, and correct DBS programming are paramount for good surgical outcomes. Nonetheless, DBS still has many limitations: axial symptoms and signs, such as speech, balance and gait, do not improve to the same extent as appendicular symptoms and can even be worsened as a direct or indirect consequence of surgery and stimulation. In addition, there are still unanswered questions regarding patient's selection, surgical planning and programming techniques, such as the role of surgicogenomics, more precise imaging-based lead placement, new brain targets, advanced programming strategies and hardware features. The net effect of these innovations should not only be to refine the beneficial effect we currently observe on selected symptoms and signs but also to improve treatment resistant facets of PD, such as axial and non-motor features. In this review, we discuss the current state of the art regarding DBS selection, implant, and programming, and explore new advances in the DBS field.
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Affiliation(s)
- Carina França
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Rafael Bernhart Carra
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo, SP, Brazil
| | - Juliete Melo Diniz
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Divisão de Neurocirurgia Funcional, São Paulo, SP, Brazil
| | - Renato Puppi Munhoz
- University of Toronto, Toronto Western Hospital, Movement Disorders Centre, Toronto, ON, Canada
| | - Rubens Gisbert Cury
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Centro de Distúrbios do Movimento, São Paulo, SP, Brazil
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23
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Abstract
Epidural stimulation of the motor cortex (eMCS) was devised in the 1990's, and has now largely supplanted thalamic stimulation for neuropathic pain relief. Its mechanisms of action involve activation of multiple cortico-subcortical areas initiated in the thalamus, with involvement of endogenous opioids and descending inhibition toward the spinal cord. Evidence for clinical efficacy is now supported by at least seven RCTs; benefits may persist up to 10 years, and can be reasonably predicted by preoperative use of non-invasive repetitive magnetic stimulation (rTMS). rTMS first developed as a means of predicting the efficacy of epidural procedures, then as an analgesic method on its own right. Reasonable evidence from at least six well-conducted RCTs favors a significant analgesic effect of high-frequency rTMS of the motor cortex in neuropathic pain (NP), and less consistently in widespread/fibromyalgic pain. Stimulation of the dorsolateral frontal cortex (DLPFC) has not proven efficacious for pain, so far. The posterior operculo-insular cortex is a new and attractive target but evidence remains inconsistent. Transcranial direct current stimulation (tDCS) is applied upon similar targets as rTMS and eMCS; it does not elicit action potentials but modulates the neuronal resting membrane state. tDCS presents practical advantages including low cost, few safety issues, and possibility of home-based protocols; however, the limited quality of most published reports entails a low level of evidence. Patients responsive to tDCS may differ from those improved by rTMS, and in both cases repeated sessions over a long time may be required to achieve clinically significant relief. Both invasive and non-invasive procedures exert their effects through multiple distributed brain networks influencing the sensory, affective and cognitive aspects of chronic pain. Their effects are mainly exerted upon abnormally sensitized pathways, rather than on acute physiological pain. Extending the duration of long-term benefits remains a challenge, for which different strategies are discussed in this review.
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Affiliation(s)
- Luis Garcia-Larrea
- Central Integration of Pain (NeuroPain) Lab, Lyon Center for Neuroscience (CRNL), INSERM U1028, University Claude Bernard Lyon 1, Villeurbanne, France - .,University Hospital Pain Center (CETD), Neurological Hospital, Hospices Civils de Lyon, Lyon, France -
| | - Charles Quesada
- Central Integration of Pain (NeuroPain) Lab, Lyon Center for Neuroscience (CRNL), INSERM U1028, University Claude Bernard Lyon 1, Villeurbanne, France.,Department of Physiotherapy, Sciences of Rehabilitation Institute (ISTR), University Claude Bernard Lyon 1, Villeurbanne, France
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24
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Chimenti RL, Rakel BA, Dailey DL, Vance CGT, Zimmerman MB, Geasland KM, Williams JM, Crofford LJ, Sluka KA. Test-Retest Reliability and Responsiveness of PROMIS Sleep Short Forms Within an RCT in Women With Fibromyalgia. Front Pain Res 2022; 2:682072. [PMID: 35295526 PMCID: PMC8915631 DOI: 10.3389/fpain.2021.682072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Nonrestorative sleep is commonly reported by individuals with fibromyalgia, but there is limited information on the reliability and responsiveness of self-reported sleep measures in this population. Objectives: (1) Examine the reliability and validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures in women with fibromyalgia, and (2) Determine the responsiveness of the PROMIS sleep measures to a daily transcutaneous electrical nerve stimulation (TENS) intervention in women with fibromyalgia over 4 weeks compared with other measures of restorative sleep. Methods: In a double-blinded, dual-site clinical trial, 301 women with fibromyalgia were randomly assigned to utilize either Active-TENS, Placebo-TENS, or No-TENS at home. Measures were collected at baseline and after 4 weeks of treatment. To assess self-reported sleep, the participants completed three PROMIS short forms: Sleep Disturbance, Sleep-Related Impairment, Fatigue, and the Pittsburgh Sleep Quality Index (PSQI). To assess device-measured sleep, actigraphy was used to quantify total sleep time, wake after sleep onset, and sleep efficiency. Linear mixed models were used to examine the effects of treatment, time, and treatment*time interactions. Results: The PROMIS short forms had moderate test–retest reliability (ICC 0.62 to 0.71) and high internal consistency (Cronbach's alpha 0.89 to 0.92). The PROMIS sleep measures [mean change over 4 weeks, 95% confidence interval (CI)], Sleep Disturbance: −1.9 (−3.6 to −0.3), Sleep-Related Impairment: −3 (−4.6 to −1.4), and Fatigue: −2.4 (−3.9 to −0.9) were responsive to improvement in restorative sleep and specific to the Active-TENS group but not in the Placebo-TENS [Sleep Disturbance: −1.3 (−3 to 0.3), Sleep-Related Impairment: −1.2 (−2.8 to 0.4), Fatigue: −1.1 (−2.7 to 0.9)] or No-TENS [Sleep Disturbance: −0.1 (−1.6 to 1.5), Sleep-Related Impairment: −0.2 (−1.7 to 1.4), Fatigue: –.3 (−1.8 to 1.2)] groups. The PSQI was responsive but not specific with improvement detected in both the Active-TENS: −0.9 (−1.7 to −0.1) and Placebo-TENS: −0.9 (−1.7 to 0) groups but not in the No-TENS group: −0.3 (−1.1 to 0.5). Actigraphy was not sensitive to any changes in restorative sleep with Active-TENS [Sleep Efficiency: −1 (−2.8 to 0.9), Total Sleep Time: 3.3 (−19.8 to 26.4)]. Conclusion: The PROMIS sleep measures are reliable, valid, and responsive to improvement in restorative sleep in women with fibromyalgia. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT01888640.
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Affiliation(s)
- Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Barbara A Rakel
- College of Nursing, University of Iowa, Iowa City, IA, United States
| | - Dana L Dailey
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States.,Department of Physical Therapy, St. Ambrose University, Davenport, IA, United States
| | - Carol G T Vance
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Miriam B Zimmerman
- College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Katharine M Geasland
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
| | - Jon M Williams
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, United States
| | - Leslie J Crofford
- Department of Medicine/Rheumatology & Immunology, Vanderbilt University, Nashville, TN, United States
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, United States
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25
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Wu Y, Zhu F, Chen W, Zhang M. Effects of transcutaneous electrical nerve stimulation (TENS) in people with knee osteoarthritis: A systematic review and meta-analysis. Clin Rehabil 2021; 36:472-485. [PMID: 34971318 DOI: 10.1177/02692155211065636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effects of Transcutaneous Electric Nerve Stimulation (TENS) on pain, function, walking ability and stiffness in people with Knee osteoarthritis (KOA). DESIGN Systematic review and meta-analysis of randomized controlled trials. METHODS We searched MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), clinicaltrials.gov and Web of Science (last search November 2021) for randomized controlled trials. The Cochrane Risk of Bias Tool was used for the included studies, and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to interpret the certainty of results. Standardized Mean Differences (SMDs) and 95% confidence interval (CI) were calculated for meta-analysis. RESULTS Twenty-nine studies were found (1398 people, age range 54-85, 74% are female) and fourteen were included in this review. Intervention duration was divided as short term (immediately after intervention), medium term (<four weeks) and long term (≥ four weeks). Active TENS showed greater improvement in Visual Analogue Scale (VAS) than sham TENS.Combining TENS with other interventions produced superior outcomes compared with other interventions for VAS in all the terms. In the meanwhile, TENS combined with other interventions was superior to other interventions for the pain subgroup of Western Ontario and McMaster Universities Arthritis Index in the medium term and long term. TENS combined with other interventions was superior to other interventions for function in the medium term and long term. CONCLUSION TENS could significantly relieve pain, decrease dysfunction and improve walking ability in people with KOA, but it is not effective for stiffness.
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Affiliation(s)
- Yu Wu
- Graduate School, 38044Xuzhou Medical University, Xuzhou, Jiangsu, 221000, China.,The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
| | - Feilong Zhu
- Graduate School, 38044Xuzhou Medical University, Xuzhou, Jiangsu, 221000, China.,The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
| | - Wei Chen
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
| | - Ming Zhang
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Rehabilitation Hospital, Xuzhou, China
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26
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Ren H, Liu J, Liu Y, Yu C, Bao G, Kang H. Comparative effectiveness of low-level laser therapy with different wavelengths and transcutaneous electric nerve stimulation in the treatment of pain caused by temporomandibular disorders: A systematic review and network meta-analysis. J Oral Rehabil 2021; 49:138-149. [PMID: 34289157 DOI: 10.1111/joor.13230] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To assess the efficacy of low-level laser therapy (LLLT) with different wavelengths and transcutaneous electric nerve stimulation (TENS) and explore the optimal wavelength range of laser application in the treatment of pain caused by temporomandibular disorders (TMD). METHODS An electronic search on PubMed, Cochrane Library, Embase, Scopus and Web of Science was undertaken to identify the randomised clinical trials (RCTs) published from database inception to 16 April 2021, aiming to compare the effects of LLLT with different wavelengths (632.8-672 nm, 780-904 nm, and 910-1100 nm) or TENS or placebo group on TMD patients pain reduction. In addition, manual search of the studies was performed. The reviewers assessed the risk of bias of individual studies with the Cochrane risk of bias tool and excluded the RCTs with a high risk of bias in any field. Meanwhile, the reviewers, after performing the network meta-analysis, assessed the quality of evidence, which contributed to network estimate via the GRADE framework. RESULTS Twenty-seven RCTs with 969 patients with TMD were included. In the meta-analysis, all treatment groups showed an overall improvement in pain scores, when compared with the placebo group. LLLT with wavelength ranging from 910 nm to 1100 nm produced more pain relief in the visual analogue scale (VAS) immediately after treatment [mean difference (MD) = 4.68, 95% confidence interval (CI):(3.08,6.28)]. After one-month follow-up, LLLT with wavelength ranging from 910 nm to 1100 nm also showed superior pain-relieving effects [MD = 3.61, 95% CI: (-1.77, 8.99)]. However, no significant difference was observed. Based on the SUCRA ranking, L3 ranked first immediately after treatment and 1 month later. CONCLUSION The results of the meta-analysis showed the LLLT had better short-term efficacy than TENS in the treatment of pain caused by TMD. Better results can be achieved with higher wavelengths. Therefore, we recommended to treat TMD using LLLT with wavelength ranging from 910 nm to 1100 nm.
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Affiliation(s)
- Hui Ren
- Department of Temporomandibular joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, China
| | - Jingying Liu
- Department of Temporomandibular joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, China
| | - Yang Liu
- Department of Temporomandibular joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, China
| | - Caiyun Yu
- Department of Temporomandibular joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, China
| | - Guangjie Bao
- Key Laboratory of Stomatology of State Ethnic Affairs Commission, Northwest Minzu University, Lanzhou, China
| | - Hong Kang
- Department of Temporomandibular joint and Occlusion, School/Hospital of Stomatology, Lanzhou University, Lanzhou, China
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27
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Agost-González A, Escobio-Prieto I, Pareja-Leal AM, Casuso-Holgado MJ, Blanco-Diaz M, Albornoz-Cabello M. Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review. Healthcare (Basel) 2021; 9:healthcare9070879. [PMID: 34356261 PMCID: PMC8306496 DOI: 10.3390/healthcare9070879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Percutaneous electrical stimulation and transcutaneous electrical stimulation (PTNS and TTNS) of the posterior tibial nerve are internationally recognized treatment methods that offer advantages in terms of treating patients with overactive bladder (OAB) who present with urinary incontinence (UI). This article aims to analyze the scientific evidence for the treatment of OAB with UI in adults using PTNS versus TTNS procedures in the posterior tibial nerve. METHODS A systematic review was conducted, between February and May 2021 in the Web of Science and Scopus databases, in accordance with the PRISMA recommendations. RESULTS The research identified 259 studies, 130 of which were selected and analyzed, with only 19 used according to the inclusion requirements established. The greatest effectiveness, in reducing UI and in other parameters of daily voiding and quality of life, was obtained by combining both techniques with other treatments, pharmacological treatments, or exercise. CONCLUSIONS TTNS has advantages over PTNS as it is more comfortable for the patient even though there is equality of both therapies in the outcome variables. More research studies are necessary in order to obtain clear scientific evidence.
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Affiliation(s)
- Aida Agost-González
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (A.A.-G.); (M.J.C.-H.); (M.A.-C.)
| | - Isabel Escobio-Prieto
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (A.A.-G.); (M.J.C.-H.); (M.A.-C.)
- Correspondence:
| | | | - María Jesús Casuso-Holgado
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (A.A.-G.); (M.J.C.-H.); (M.A.-C.)
| | - María Blanco-Diaz
- Departamento de Fisioterapia, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, 33006 Oviedo, Spain;
| | - Manuel Albornoz-Cabello
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (A.A.-G.); (M.J.C.-H.); (M.A.-C.)
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28
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Childs DS, Le-Rademacher JG, McMurray R, Bendel M, O'Neill C, Smith TJ, Loprinzi CL. Randomized Trial of Scrambler Therapy for Chemotherapy-Induced Peripheral Neuropathy: Crossover Analysis. J Pain Symptom Manage 2021; 61:1247-1253. [PMID: 33249081 DOI: 10.1016/j.jpainsymman.2020.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Preliminary trials report that Scrambler Therapy, a form of electroanalgesia, may improve discomfort from chemotherapy-induced peripheral neuropathy (CIPN). OBJECTIVE The objective of this phase II, randomized controlled trial was to evaluate the efficacy of Scrambler therapy vs. transcutaneous electrical nerve stimulation (TENS) in treating CIPN. METHODS Fifty patients were accrued for the first half of this two-part, crossover trial consisting of a 2-week treatment period with either Scrambler or TENS, followed by an 8-week observation period, and then crossover treatment. Twenty-two patients proceeded to the crossover phase. The primary means of assessment was patient-reported outcomes, including symptom severity scales and Global Impression of Change questionnaires. Symptoms were assessed daily during the treatment period and weekly during an 8-week observation period. RESULTS A 50% or greater reduction in primary symptom (pain or tingling) score on the last day of treatment was achieved by 6 of 10 Scrambler-treated patients (60%) and 3 of 12 TENS-treated patients (25%) after crossover (P = 0.11). By day 4 of treatment, the two arms diverged with respect to mean change in primary symptom score; this effect was largely carried through to the end of the two-week treatment period. Similarly, Scrambler therapy appeared better than TENS when assessed by Global Impression of Change for neuropathy, pain, and overall quality of life. CONCLUSIONS Similar findings from the initial randomization and crossover phases of this study support further evaluation of the efficacy of Scrambler therapy in alleviating CIPN symptoms. Evaluation in a larger, randomized controlled trial with standardized treatment is warranted.
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Affiliation(s)
- Daniel S Childs
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Jennifer G Le-Rademacher
- Department of Health Sciences Research, Section of Cancer Center Statistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan McMurray
- Department of Health Sciences Research, Section of Cancer Center Statistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Markus Bendel
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie O'Neill
- Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas J Smith
- Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University, Baltimore, Maryland, USA
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Cruz E, Miller C, Zhang W, Rogers K, Lee HJ, Wells Y, Cloud GC, Lannin NA. Does non-implanted electrical stimulation reduce post-stroke urinary or fecal incontinence? A systematic review with meta-analysis. Int J Stroke 2021; 17:378-388. [PMID: 33724094 DOI: 10.1177/17474930211006301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Urinary and fecal incontinence are disabling impairments after stroke that can be clinically managed with electrical stimulation. AIM The purpose of this systematic review was to determine the effectiveness of non-implanted electrical stimulation to reduce the severity of post-stroke incontinence. SUMMARY OF REVIEW Clinical trials of non-implanted electrical stimulation applied for the purposes of treating post-stroke incontinence were searched in MEDLINE, EMBASE, CINAHL, PEDro, and CENTRAL. From a total of 5043 manuscripts, 10 trials met the eligibility criteria (n = 894 subjects). Nine trials reported urinary incontinence severity outcomes enabling meta-analysis of transcutaneous electrical nerve stimulation (TENS; five trials) and electroacupuncture (four trials). Studies provide good-to-fair quality evidence that TENS commenced <3 months post-stroke has a large effect on urinary continence (SMD = -3.40, 95% CI -4.46 to -2.34) and a medium effect when commenced >3 months after stroke (SMD = -0.67, 95% CI -1.09 to -0.26). Electroacupuncture has a large effect when administered >5 times a week (SMD = -2.32, 95% CI -2.96 to -1.68) and a small effect when administered five times a week (SMD = -0.44, 95% CI -0.69 to -0.18). Only one trial reported the effect of non-implanted electrical stimulation on post-stroke fecal incontinence. CONCLUSIONS Published trials evaluating the effect of non-implanted electrical stimulation on post-stroke incontinence are few and heterogenous. Synthesized trials suggest that early and frequent treatment using electrical stimulation is probably more effective than sham or no treatment. Further trials measuring incontinence in an objective manner are required.
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Affiliation(s)
- Enrique Cruz
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Charne Miller
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - WenWen Zhang
- Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Austin Health, Melbourne, Australia
| | | | | | - Yvonne Wells
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Geoffrey C Cloud
- Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Natasha A Lannin
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,John Walsh Centre for Rehabilitation Research, Kolling Institute, The University of Sydney, Sydney, Australia
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30
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Ketenci A, Zure M. Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain. Turk J Phys Med Rehabil 2021; 67:1-10. [PMID: 33948537 DOI: 10.5606/tftrd.2021.8216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/01/2021] [Indexed: 12/14/2022] Open
Abstract
Low back pain is a common and important cause of disability. Chronic pain increases disability and cost. In this review, we discuss pharmacological and non-pharmacological treatment approaches for chronic low back pain in the light of current data and guidelines.
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31
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Garcia GT, Ribeiro RF, Faria Santos IB, Gomes FDC, de Melo-Neto JS. Electrical Stimulation of PC 6 to Control Chemotherapy-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review and Meta-Analysis. Med Acupunct 2021; 33:22-44. [PMID: 33613810 DOI: 10.1089/acu.2020.1431] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: A complementary treatment for managing chemotherapy-induced nausea and vomiting (CINV) with promising results is electrostimulation of Pericardium 6 (PC 6; Neiguan). This review was conducted to evaluate the effects of electrostimulation therapy at PC 6 to control CINV in patients with cancer. The review was registered on PROSPERO (CRD42018087753). Methods: This systematic review and meta-analysis of clinical trials was accomplished according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies written in English, Portuguese, or Spanish that met the eligibility criteria organized according to the PICO [Patient, Problem or Population; Intervention; Comparison, Control, or comparator; Outcome(s)] anagram were included. Descriptors used to search the databases were identified and selected according to the Medical Subject Headings of the National Library of Medicine. The primary outcomes evaluated were the frequency and severity of nausea, vomiting, and general emesis after the experimental protocol. The secondary outcomes evaluated were the numbers of antiemetic pills taken and the patients' quality of life. Results: Fourteen articles were included. There was a reduction in the mean number of episodes of acute nausea (mean difference [MD] = -2.08; 95% confidence interval [95%CI] = -2.76, -1.39) and acute vomiting (MD = -0.91; 95% CI = -1.39, -0.42) or delayed (MD = -0.85; 95%CI = -1.47, -0.23) in patients given the treatment. The other analyses of nausea, vomiting and emesis showed no differences. Conclusions: Electrostimulation at PC6 has an effect on controlling general emesis, and acute nausea and vomiting in different phases of recovery from chemotherapy in patients with cancer.
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32
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Doshi TL, Staats PS. fMRI in vagus nerve stimulation for migraine: a biomarker-based approach to pain research. Reg Anesth Pain Med 2021; 46:467-468. [PMID: 33589433 DOI: 10.1136/rapm-2020-102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Tina L Doshi
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Peter S Staats
- National Spine and Pain Centers, Atlantic Beach, Florida, USA
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33
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de Abreu GE, de Souza LA, da Fonseca MLV, Barbosa TBC, de Mello ERD, Nunes ANB, Barroso UO Jr. Parasacral Transcutaneous Electrical Nerve Stimulation for the Treatment of Children and Adolescents with Bladder and Bowel Dysfunction: A Randomized Clinical Trial. J Urol 2021; 205:1785-91. [PMID: 33525925 DOI: 10.1097/JU.0000000000001579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Parasacral transcutaneous electrical nerve stimulation has been used to manage lower urinary tract symptoms refractory to standard urotherapy. Nevertheless, its actual effectiveness in treatment of bladder and bowel dysfunction remains to be established. We sought to evaluate the effectiveness of parasacral transcutaneous electrical nerve stimulation in the treatment of children with bladder and bowel dysfunction. MATERIALS AND METHODS This was a randomized clinical trial conducted with children and adolescents of 5-17 years of age diagnosed with bladder and bowel dysfunction. Patients with neurological or anatomical abnormalities of urinary or digestive tracts, those unable to attend treatment sessions 3 times a week, individuals with diabetes mellitus or diabetes insipidus and those using anticholinergic drugs or laxatives were excluded from the study. The sample was divided into 2 groups: a control group submitted to standard urotherapy plus sham electrotherapy applied to the scapular region and a treatment group submitted to urotherapy plus parasacral transcutaneous electrical nerve stimulation. All the patients were submitted to 3, 20-minute electrotherapy (parasacral transcutaneous electrical nerve stimulation or sham) sessions/week for a total of 20 sessions. RESULTS Forty patients were evaluated, 20 in the control group and 20 in the treatment group. Mean age (±standard deviation) was 8.4±2.8 years and 52.5% were male. In 15 patients (37.5%), rectal diameter was ≥3 cm. Lower urinary tract symptoms improved in both groups following treatment, with no statistically significant differences in Dysfunctional Voiding Scoring System score, lower urinary tract symptoms or uroflowmetry patterns between the groups. Intragroup evaluation showed a significant improvement in enuresis in the treatment group. There was a significant improvement in functional constipation post-intervention in treatment group compared to control group (70% vs 20%, p=0.004). CONCLUSIONS Parasacral transcutaneous electrical nerve stimulation is effective for treatment of bladder and bowel dysfunction in children and adolescents, particularly insofar as functional constipation is concerned.
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Parseliunas A, Paskauskas S, Kubiliute E, Vaitekunas J, Venskutonis D. Transcutaneous Electric Nerve Stimulation Reduces Acute Postoperative Pain and Analgesic Use After Open Inguinal Hernia Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial. J Pain 2020; 22:533-544. [PMID: 33309784 DOI: 10.1016/j.jpain.2020.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/01/2020] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
In this randomized, double-blind, placebo-controlled trial, we evaluated the role of transcutaneous electrical nerve stimulation (TENS) in the multimodal treatment (nonopioid 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 to 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< .001). The pressure pain threshold and maximal tolerable pressure in the hernia side were equal before the TENS procedure in both groups (P= .84), but after the procedure, these were higher in TENS group (P< .001). Additional nonopioid analgesics requirements were lower in the TENS group on the first and second postoperative days (P< .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 nonpharmacologic intervention to reduce postoperative 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.
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Affiliation(s)
- Audrius Parseliunas
- Department of General Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Saulius Paskauskas
- Department of Obstetrics and Gynaecology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Egle Kubiliute
- Department of General Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jovydas Vaitekunas
- Department of General Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Donatas Venskutonis
- Department of General Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Zhang Y, Huang Y, Li H, Yan Z, Zhang Y, Liu X, Hou X, Chen W, Tu Y, Hodges S, Chen H, Liu B, Kong J. Transcutaneous auricular vagus nerve stimulation (taVNS) for migraine: an fMRI study. Reg Anesth Pain Med 2020; 46:145-150. [PMID: 33262253 DOI: 10.1136/rapm-2020-102088] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/26/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dysfunction of the thalamocortical connectivity network is thought to underlie the pathophysiology of the migraine. This current study aimed to explore the thalamocortical connectivity changes during 4 weeks of continuous transcutaneous vagus nerve stimulation (taVNS) treatment on migraine patients. METHODS 70 migraine patients were recruited and randomized in an equal ratio to receive real taVNS or sham taVNS treatments for 4 weeks. Resting-state functional MRI was collected before and after treatment. The thalamus was parceled into functional regions of interest (ROIs) on the basis of six priori-defined cortical ROIs covering the entire cortex. Seed-based functional connectivity analysis between each thalamic subregion and the whole brain was further compared across groups after treatment. RESULTS Of the 59 patients that finished the study, those in the taVNS group had significantly reduced number of migraine days, pain intensity and migraine attack times after 4 weeks of treatment compared with the sham taVNS. Functional connectivity analysis revealed that taVNS can increase the connectivity between the motor-related thalamus subregion and anterior cingulate cortex/medial prefrontal cortex, and decrease the connectivity between occipital cortex-related thalamus subregion and postcentral gyrus/precuneus. CONCLUSION Our findings suggest that taVNS can relieve the symptoms of headache as well as modulate the thalamocortical circuits in migraine patients. The results provide insights into the neural mechanism of taVNS and reveal potential therapeutic targets for migraine patients.
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Affiliation(s)
- Yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yiting Huang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hui Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhaoxian Yan
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Ying Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xian Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaoyan Hou
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Weicui Chen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sierra Hodges
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Helen Chen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bo Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Witte JP, Kravchenko D, Marinova M, Küborth K, Radbruch L, Mücke M, Conrad R. Matrix stimulation in chronic pruritus: A randomized controlled study. J Dermatol 2020; 47:1166-1174. [PMID: 32839976 DOI: 10.1111/1346-8138.15492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/07/2020] [Indexed: 10/23/2022]
Abstract
Chronic pruritus is one of the main symptoms in dermatology. We investigated a new intervention for chronic pruritus by neurostimulation through matrix electrodes. In this randomized controlled trial, 29 patients with chronic pruritus caused by a variety of dermatological diseases were allocated to an experimental group (EG; n = 14, 4-Hz neurostimulation of the itching area through matrix electrodes) or the control group (CG; n = 15, placement of matrix electrodes without neurostimulation). Outcome measures were the itching sensation as measured by a Numerical Rating Scale immediately after the intervention and the intermediate effect measured by the average itching sensation on the day before the intervention compared with the average itching sensation on day 1, 2 and 3 after the intervention. Regarding the short-term effect on itching, the anova showed a significant interaction effect for the 5-min stimulation with a larger reduction in the EG with a large effect size of d = 1.10. The average reduction in itching intensity was 78.2% for the EG compared with 34.3% for the CG. For the intermediate effect, no significant interaction was found (F = 1.721, P = 0.199). Comparing the itching sensation at day 0 with day 3, the interaction effect showed a statistical trend toward a greater reduction in the EG (F = 3.178, P = 0.086; statistical trend, d = 0.69). This study proved that neurostimulation through matrix electrodes is effective in the short-term reduction of itching in patients with chronic pruritus caused by dermatological diseases. Additional studies are needed with larger patient pools and covering longer study periods.
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Affiliation(s)
- Jan-Philipp Witte
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Dimitrij Kravchenko
- Department of Radiology, Medical School and Hospital, University Hospital Bonn, Bonn, Germany
| | - Milka Marinova
- Department of Radiology, Medical School and Hospital, University Hospital Bonn, Bonn, Germany
| | - Karsten Küborth
- Departments of, Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Martin Mücke
- Center for Rare Diseases Bonn (ZSEB), University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
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Barcala-Furelos R, González-Represas A, Rey E, Martínez-Rodríguez A, Kalén A, Marques O, Rama L. Is Low-Frequency Electrical Stimulation a Tool for Recovery after a Water Rescue? A Cross-Over Study with Lifeguards. Int J Environ Res Public Health 2020; 17:ijerph17165854. [PMID: 32806727 PMCID: PMC7460120 DOI: 10.3390/ijerph17165854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/26/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the degree to which transcutaneous electrical stimulation (ES) enhanced recovery following a simulated water rescue. Twenty-six lifeguards participated in this study. The rescue consisted of swimming 100 m with fins and rescue-tube: 50 m swim approach and 50 m tow-in a simulated victim. Blood lactate clearance, rated perceived effort (RPE), and muscle contractile properties were evaluated at baseline, after the water rescue, and after ES or passive-recovery control condition (PR) protocol. Tensiomiography, RPE, and blood lactate basal levels indicated equivalence between both groups. There was no change in tensiomiography from pre to post-recovery and no difference between recovery protocols. Overall-RPE, legs-RPE and arms-RPE after ES (mean ± SD; 2.7 ± 1.53, 2.65 ± 1.66, and 2.30 ± 1.84, respectively) were moderately lower than after PR (3.57 ± 2.4, 3.71 ± 2.43, and 3.29 ± 1.79, respectively) (p = 0.016, p = 0.010, p = 0.028, respectively). There was a significantly lower blood lactate level after recovery in ES than in PR (mean ± SD; 4.77 ± 1.86 mmol·L-1 vs. 6.27 ± 3.69 mmol·L-1; p = 0.045). Low-frequency ES immediately after a water rescue is an effective recovery strategy to clear out blood lactate concentration.
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Affiliation(s)
- Roberto Barcala-Furelos
- REMOSS Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (A.K.)
- CLINURSID Network Research, Department of Psychiatry, Radiology and Public Health, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | - Alicia González-Represas
- Department of Functional Biology and Health Sciences, Faculty of Physiotherapy, University of Vigo, 36005 Vigo, Spain;
| | - Ezequiel Rey
- REMOSS Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (A.K.)
- Correspondence:
| | - Alicia Martínez-Rodríguez
- Department of Physiotherapy, Medicine and Biomedical Sciences, Universidade da Coruña, 15006 La Coruña, Spain;
| | - Anton Kalén
- REMOSS Research Group, Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain; (R.B.-F.); (A.K.)
| | - Olga Marques
- Faculty of Sports Sciences and Physical Education, University of Coimbra, 3040-156 Coimbra, Portugal; (O.M.); (L.R.)
- Research Unit for Sport and Physical Activity (CIDAF), 3040-156 Coimbra, Portugal
| | - Luís Rama
- Faculty of Sports Sciences and Physical Education, University of Coimbra, 3040-156 Coimbra, Portugal; (O.M.); (L.R.)
- Research Unit for Sport and Physical Activity (CIDAF), 3040-156 Coimbra, Portugal
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Harvie HS, Amundsen CL, Neuwahl SJ, Honeycutt AA, Lukacz ES, Sung VW, Rogers RG, Ellington D, Ferrando CA, Chermansky CJ, Mazloomdoost D, Thomas S. Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial. J Urol 2020; 203:969-77. [PMID: 31738113 DOI: 10.1097/JU.0000000000000656] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Sacral neuromodulation and intradetrusor onabotulinumtoxinA injection are therapies for refractory urgency urinary incontinence. Sacral neuromodulation involves surgical implantation of a device that can last 4 to 6 years while onabotulinumtoxinA therapy involves serial office injections. We assessed the cost-effectiveness of 2-stage implantation sacral neuromodulation vs 200 units onabotulinumtoxinA for the treatment of urgency urinary incontinence. MATERIALS AND METHODS Prospective economic evaluation was performed concurrent with the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment) randomized trial of 386 women with 6 or more urgency urinary incontinence episodes on a 3-day diary. Analysis is from the health care system perspective with primary within-trial analysis for 2 years and secondary 5-year decision analysis. Costs are in 2018 U.S. dollars. Effectiveness was measured in quality adjusted life-years (QALYs) and reductions in urgency urinary incontinence episodes per day. We generated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. RESULTS Two-year costs were higher for sacral neuromodulation than for onabotulinumtoxinA ($35,680 [95% CI 33,920-37,440] vs $7,460 [95% CI 5,780-9,150], p <0.01), persisting through 5 years ($36,550 [95% CI 34,787-38,309] vs $12,020 [95% CI 10,330-13,700], p <0.01). At 2 years there were no differences in mean reduction in urgency urinary incontinence episodes per day (-3.00 [95% CI -3.38 - -2.62] vs -3.12 [95% CI -3.48 - -2.76], p=0.66) or QALYs (1.39 [95% CI 1.34-1.44] vs 1.41 [95% CI 1.36-1.45], p=0.60). The probability that sacral neuromodulation is cost-effective relative to onabotulinumtoxinA is less than 0.025 for all willingness to pay values below $580,000 per QALY at 2 years and $204,000 per QALY at 5 years. CONCLUSIONS Although both treatments were effective, the high cost of sacral neuromodulation is not good value for treating urgency urinary incontinence compared to 200 units onabotulinumtoxinA.
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Abstract
BACKGROUND Shock wave therapy has seen widespread use since the 1990s to treat various musculoskeletal disorders including rotator cuff disease, but evidence of its efficacy remains equivocal. OBJECTIVES To determine the benefits and harms of shock wave therapy for rotator cuff disease, with or without calcification, and to establish its usefulness in the context of other available treatment options. SEARCH METHODS We searched Ovid MEDLINE, Ovid Embase, CENTRAL, ClinicalTrials.gov and the WHO ICTRP up to November 2019, with no restrictions on language. We reviewed the reference lists of retrieved trials to identify potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that used quasi-randomised methods to allocate participants, investigating participants with rotator cuff disease with or without calcific deposits. We included trials of comparisons of extracorporeal or radial shock wave therapy versus any other intervention. Major outcomes were pain relief greater than 30%, mean pain score, function, patient-reported global assessment of treatment success, quality of life, number of participants experiencing adverse events and number of withdrawals due to adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data and assessed the certainty of evidence using GRADE. The primary comparison was shock wave therapy compared to placebo. MAIN RESULTS Thirty-two trials (2281 participants) met our inclusion criteria. Most trials (25) included participants with rotator cuff disease and calcific deposits, five trials included participants with rotator cuff disease and no calcific deposits, and two trials included a mixed population of participants with and without calcific deposits. Twelve trials compared shock wave therapy to placebo, 11 trials compared high-dose shock wave therapy (0.2 mJ/mm² to 0.4 mJ/mm² and above) to low-dose shock wave therapy. Single trials compared shock wave therapy to ultrasound-guided glucocorticoid needling, ultrasound-guided hyaluronic acid injection, transcutaneous electric nerve stimulation (TENS), no treatment or exercise; dual session shock wave therapy to single session therapy; and different delivery methods of shock wave therapy. Our main comparison was shock wave therapy versus placebo and results are reported for the 3 month follow up. All trials were susceptible to bias; including selection (74%), performance (62%), detection (62%), and selective reporting (45%) biases. No trial measured participant-reported pain relief of 30%. However, in one trial (74 participants), at 3 months follow up, 14/34 participants reported pain relief of 50% or greater with shock wave therapy compared with 15/40 with placebo (risk ratio (RR) 1.10, 95% confidence interval (CI) 0.62 to 1.94); low-quality evidence (downgraded for bias and imprecision). Mean pain (0 to 10 scale, higher scores indicate more pain) was 3.02 points in the placebo group and 0.78 points better (0.17 better to 1.4 better; clinically important change was 1.5 points) with shock wave therapy (9 trials, 608 participants), moderate-quality evidence (downgraded for bias). Mean function (scale 0 to 100, higher scores indicate better function) was 66 points with placebo and 7.9 points better (1.6 better to 14 better, clinically important difference 10 points) with shock wave therapy (9 trials, 612 participants), moderate-quality evidence (downgraded for bias). Participant-reported success was reported by 58/150 people in shock wave therapy group compared with 35/137 people in placebo group (RR 1.59, 95% CI 0.87 to 2.91; 6 trials, 287 participants), low-quality evidence (downgraded for bias and imprecision). None of the trials measured quality of life. Withdrawal rate or adverse event rates may not differ between extracorporeal shock wave therapy and placebo, but we are uncertain due to the small number of events. There were 11/34 withdrawals in the extracorporeal shock wave therapy group compared with 13/40 withdrawals in the placebo group (RR 0.75, 95% CI 0.43 to 1.31; 7 trials, 581 participants) low-quality evidence (downgraded for bias and imprecision); and 41/156 adverse events with extracorporeal shock wave therapy compared with 10/139 adverse events in the placebo group (RR 3.61, 95% CI 2.00 to 6.52; 5 trials, 295 participants) low-quality evidence (downgraded for bias and imprecision). Subgroup analyses indicated that there were no between-group differences in pain and function outcomes in participants who did or did not have calcific deposits in the rotator cuff. AUTHORS' CONCLUSIONS Based upon the currently available low- to moderate-certainty evidence, there were very few clinically important benefits of shock wave therapy, and uncertainty regarding its safety. Wide clinical diversity and varying treatment protocols means that we do not know whether or not some trials tested subtherapeutic doses, possibly underestimating any potential benefits. Further trials of extracorporeal shock wave therapy for rotator cuff disease should be based upon a strong rationale and consideration of whether or not they would alter the conclusions of this review. A standard dose and treatment protocol should be decided upon before further research is conducted. Development of a core set of outcomes for trials of rotator cuff disease and other shoulder disorders would also facilitate our ability to synthesise the evidence.
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Affiliation(s)
- Stephen J Surace
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Jessica Deitch
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Renea V Johnston
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
| | - Rachelle Buchbinder
- Monash UniversityMonash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMelbourneAustralia
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Rueb JJ, Pizarro-Berdichevsky J, Goldman HB. 17-Year Single Center Retrospective Review of Rate, Risk Factors and Outcomes of Lead Breakage during Sacral Neuromodulation Lead Removal. J Urol 2020; 203:1178-83. [PMID: 31909689 DOI: 10.1097/JU.0000000000000740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE One risk of removal of a tined sacral neuromodulation lead is breakage, resulting in a retained lead fragment. We report lead breakage rates, risk factors and outcomes of retained fragments. MATERIALS AND METHODS We report on 464 tined lead removals from 2002 to 2018. Clinical and surgical factors were reviewed and appropriate statistical analysis performed. Retained fragments were reviewed for fragment description and long-term complications. RESULTS A total of 464 tined lead removals were included, with 35 lead breaks identified, for a rate of 7.5% (35). Factors associated with breakage included male gender (OR 6.58, 95% CI 2.54-17.01, p=0.001) and diabetes (OR 2.42, 95% CI 1.05-5.58, p=0.019). A shorter time since implantation was protective (OR 0.86, 95% CI 0.76-0.98, p=0.002). There was no difference in breakage rate based on age, weight, history of prior revision, bilateral leads, reason for lead removal, surgical technique or surgeon. Of the 35 breaks 27 had imaging available. Of these 66% (18) broke in the tined region and 81% (22) were ghost leads. Most patients (80%, 28 of 35) with retained lead fragments received another implant. Only 1 patient had a related complication of additional surgery for pain related to the fragment. CONCLUSIONS There is a low rate of tined lead breakage during lead removal. However, it is higher than the manufacturer estimate. Protective factors include a shorter time between implant and lead revision. The most common location for lead breakage is in the region of the tines, most are ghost fragments and long-term complications are uncommon.
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Jacomo RH, Alves AT, Lucio A, Garcia PA, Lorena DCR, de Sousa JB. Transcutaneous tibial nerve stimulation versus parasacral stimulation in the treatment of overactive bladder in elderly people: a triple-blinded randomized controlled trial. Clinics (Sao Paulo) 2020; 75:e1477. [PMID: 31939564 PMCID: PMC6943254 DOI: 10.6061/clinics/2020/e1477] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To evaluate the effect of transcutaneous tibial nerve stimulation (TTNS) and transcutaneous parasacral stimulation on the treatment of overactive bladder (OAB) in elderly people and to compare the final results between groups. METHODS Fifty female volunteers, mean age 68.62 (±5.9) years, were randomly allocated into two groups: those receiving TTNS (G1, N=25) and those receiving transcutaneous parasacral stimulation (G2, N=25). The primary outcome was the International Consultation on Incontinence Questionnaire (ICIQ-OAB) score, and secondary outcomes were the International Consultation on Incontinence Questionnaire - short form (ICIQ-SF) score and 3-day bladder diary measurements. Volunteers were assessed before and after the treatment. Clinical Trials (ReBeC): RBR-9Q7J7Y. RESULTS Both groups' symptoms improved as measured by the ICIQ-OAB (G1 = <0.001; G2 = <0.001) and ICIQ-SF (G1 = <0.001; G2 = <0.001). In the 3-day bladder diary assessments after treatment, G1 showed a reduced number of nocturia (p<0.001), urgency (p<0.001) and urge urinary incontinence episodes (p<0.001), whereas G2 showed only a reduced number of nocturia episodes (p<0.001). No difference between groups was found. CONCLUSION Both of the proposed treatments were effective in the improvement of OAB symptoms, but TTNS showed a reduction in a greater number of symptoms as measured by the 3-day bladder diary. No differences were found between groups.
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Affiliation(s)
- Raquel Henriques Jacomo
- Programa de Ciencias Medicas, Faculdade de Medicina, Universidade de Brasilia, Brasilia, DF, BR
- *Corresponding author. E-mail:
| | - Aline Teixeira Alves
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Departamento de Fisioterapia, Universidade de Brasilia, Brasilia, DF, BR
| | - Adélia Lucio
- Unidade de Reabilitacao, Hospital Universitario, Universidade do Mato Grosso do Sul, Campo Grande, MS, BR
| | - Patrícia Azevedo Garcia
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Departamento de Fisioterapia, Universidade de Brasilia, Brasilia, DF, BR
| | - Dayanne Cristina Ramos Lorena
- Programa de Pos-Graduacao em Ciencias da Reabilitacao, Departamento de Fisioterapia, Universidade de Brasilia, Brasilia, DF, BR
| | - João Batista de Sousa
- Programa de Ciencias Medicas, Faculdade de Medicina, Universidade de Brasilia, Brasilia, DF, BR
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Cai H, Zhou Q, Bao G, Kong X, Gong LY. Transcutaneous electrical nerve stimulation of acupuncture points enhances therapeutic effects of oral lactulose solution on opioid-induced constipation. J Int Med Res 2019; 47:6337-6348. [PMID: 31774002 PMCID: PMC7045659 DOI: 10.1177/0300060519874539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of this study was to evaluate the therapeutic effects of transcutaneous electrical nerve stimulation (TENS) on opioid-induced constipation (OIC) and patient quality of life. Methods A total of 251 patients were randomly allocated to a treatment group, who received TENS and oral lactulose solution (n = 124), and a control group, who received only oral lactulose solution (n = 127). Constipation and quality of life after treatment were measured by comparing semiquantitative scores based on subjective symptoms. Results The defecation difficulty, incomplete defecation feeling, and overall defecation satisfaction scores of the treatment group were significantly different from those of the control group ( P = 0.018). Bowel Function Index and quality of life scores of the treatment group were significantly greater than those of the control group. The effective rates of control and treatment groups were 85.8% and 91.9%, respectively. Conclusion TENS of relevant acupuncture points significantly relieved the clinical symptoms of constipation of patients with OIC and improved their quality of life.
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Affiliation(s)
- Hu Cai
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Qinfei Zhou
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Guanai Bao
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiangming Kong
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Li-Yan Gong
- Institute of Cancer Research and Basic Medical Sciences of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Cancer Hospital of University of the Chinese Academy of Science, Hangzhou, China.,Department of Integrated Chinese Traditional Medicine and Western Medicine, Zhejiang Cancer Hospital, Hangzhou, China
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Fernández-Seguín LM, Heredia-Rizo AM, Díaz-Mancha JA, González-García P, Ramos-Ortega J, Munuera-Martínez PV. Immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation in adults with cavus foot: A randomized controlled trial. Medicine (Baltimore) 2019; 98:e18018. [PMID: 31725676 PMCID: PMC6867773 DOI: 10.1097/md.0000000000018018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cavus foot is a deformity represented by an increased and rigid medial longitudinal arch, and it is often associated with persistent pain and gait disturbances. None of the conservative conventional treatments for cavus foot have shown conclusive evidence of effectiveness, and so further is research needed to understand how to manage this condition better. This study aimed to assess the immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation of the plantar fascia in adults with idiopathic cavus foot. METHODS A randomized, single-blinded clinical trial was conducted. Sixty-eight participants with idiopathic cavus foot, as determined by an internal Moreau-Costa-Bertani angle (MCBA) less than 125° in a lateral weight-bearing foot radiograph, were equally distributed into a neuromuscular stretching group (NSG) or a control group (no intervention). The NSG underwent a single session, combining transcutaneous electrical nerve stimulation with static stretching of the plantar fascia. Primary measurements of 3 angles were taken using a lateral weight-bearing foot radiograph: the internal MCBA; the calcaneal pitch angle (CPA); and the first metatarsal declination angle (FMDA). Outcomes were collected at baseline, immediately postintervention, and 1 week after intervention. RESULTS Analysis of variance revealed a significant group effect for all angles (all, P < .05). NSG participants showed a significant increase in the internal MCBA (P = .03), and a significant decrease in the CPA (P = .01) and FMDA (P = .04) from baseline to immediately postintervention. These changes remained statistically significant 1 week after the intervention (all, P < .05). CONCLUSION The combination of static stretching and transcutaneous electrical stimulation of the plantar fascia, compared with no treatment, achieved immediate and short-term changes in the internal MCBA, the CPA, and the FMDA, which resulted in flattening the medial longitudinal plantar arch in adults with idiopathic cavus foot.
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Affiliation(s)
| | | | | | | | - Javier Ramos-Ortega
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
| | - Pedro V. Munuera-Martínez
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
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Dombek K, Costa Monteiro LM, Fontes JM, Ramos EG. Immediate effect of transcutaneous electrical nerve stimulation on urodynamic parameters of children with myelomeningocele. Neurourol Urodyn 2019; 38:2351-2358. [PMID: 31486143 DOI: 10.1002/nau.24155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/18/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the immediate response of electrical stimulation in children with neurogenic bladder (NB) due to myelomeningocele, using the urodynamic study (UDS). METHODS This is a nonrandomized intervention study with 26 children with neurogenic overactive bladder and low bladder compliance due to myelomeningocele, aged 5 to 15 years. Each child performed a routine UDS and then a second UDS, during which the electrical stimulation was applied in the parasacral region. The main outcome was the difference in the maximum bladder pressure observed between the two urodynamic studies, analyzed from the paired t test. RESULTS We found that 77% of the patients had a lower maximum bladder pressure in the test with electrostimulation compared with the ones without electrostimulation. On average, the pressure reduction after stimulation was 7.24 cmH2 O (95% confidence interval [CI], 0.35-14.14; P = .04). The reduction was even higher in children under 12 years of age, compared with the children above 12 years (11.29 cmH2 O, 95% CI, 3.47-19.12; P = .01). CONCLUSION The use of transcutaneous electrical nerve stimulation had a significant immediate effect on reducing the maximum bladder pressure during the urodynamic studies among the tested pediatric patients with NB. The results were more significant among children under 12 years of age.
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Affiliation(s)
- Kathiussa Dombek
- Bladder Dysfunction and Pediatric Urodynamics Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Lucia M Costa Monteiro
- Bladder Dysfunction and Pediatric Urodynamics Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Juliana Marin Fontes
- Bladder Dysfunction and Pediatric Urodynamics Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Eloane G Ramos
- Clinical Research Unit, National Institute of Women, Children and Adolescents Health Fernandes Figueira (IFF), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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45
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Marcolino MAZ, Hauck M, Stein C, Schardong J, Pagnussat ADS, Plentz RDM. Effects of transcutaneous electrical nerve stimulation alone or as additional therapy on chronic post-stroke spasticity: systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil 2018; 42:623-635. [PMID: 30326752 DOI: 10.1080/09638288.2018.1503736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose: To evaluate the effects and to compare transcutaneous electrical nerve stimulation protocols, alone or as additional therapy in chronic post-stroke spasticity through a systematic review and meta-analysis of randomized clinical trials.Methods: Search was conducted in MEDLINE, Cochrane Library, EMBASE and Physiotherapy Evidence Database through November 2017 (CRD42015020146). Two independent reviewers performed articles selection, data extraction and methodological quality assessment using the Cochrane Collaboration's risk of bias tool. The main outcome was spasticity assessed with Modified Ashworth Scale or other valid scale. Meta-analysis was conducted using random effects method, and pooled-effect results are mean difference with 95% confidence interval.Results: Of 6506 articles identified, 10 studies with 360 subjects were included in the review. Transcutaneous electrical nerve stimulation alone or as additional therapy is superior to placebo TENS to reduce post-stroke spasticity assessed with Modified Ashworth Scale (-0.52 [-0.74 to -0.30] p < 0.0001, 6 studies), especially in lower limbs (-0.58 [-0.82 to -0.34] p < 0.0001, 5 studies), which is in accordance with the studies that used other scales. Low frequency TENS showed a slightly larger improvement than high-frequency, but without significant difference between subgroups. Most studies present low or unclear risk of bias.Conclusion: Transcutaneous electrical nerve stimulation can provide additional reduction in chronic post-stroke spasticity, mainly as additional therapy to physical interventions. Studies with better methodological quality and larger sample are needed to increase evidence power.Implications for RehabilitationTranscutaneous electrical nerve stimulation as additional treatment to physical interventions can lead to additional reduction in chronic post-stroke spasticity.High and low frequency transcutaneous electrical nerve stimulation showed similar results, with a smaller numerical superiority of low frequency TENS.More studies are needed to substantiate the best protocol of transcutaneous electrical nerve stimulation to the treatment of spasticity.
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Affiliation(s)
- Miriam Allein Zago Marcolino
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Melina Hauck
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Cinara Stein
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Jociane Schardong
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Aline de Souza Pagnussat
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Rodrigo Della Méa Plentz
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Martínez-Rodríguez A, Senin-Camargo F, Raposo-Vidal I, Chouza-Insua M, Rodríguez-Romero B, Jácome MA. Effects of transcutaneous electrical nerve stimulation via peroneal nerve or soleus muscle on venous flow: A randomized cross-over study in healthy subjects. Medicine (Baltimore) 2018; 97:e12084. [PMID: 30200088 PMCID: PMC6133565 DOI: 10.1097/md.0000000000012084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Transcutaneous electrical nerve stimulation (TENS) is used to prevent venous stasis and thromboembolism. However, best electrostimulation parameters have yet to be established. The aim of the study was to compare the hemodynamic effects and the participants' relative discomfort of 3 TENS sequences at the maximum tolerated intensity stimulus. METHODS Twenty-four healthy university students (50% male) participated in a cross-over, randomized study. Each participant received 2 TENS sequences on peroneal nerve at 1 and 5 Hz, and the third one on soleus muscle at 5 Hz. Popliteal flow volume (FV) and peak velocity (PV) were measured using Doppler ultrasound and the relative change from basal values was recorded. Discomfort questionnaires -visual analogue scale (VAS) and verbal rating scale (VRS)- were also administered to compare sensations among the three applications. RESULTS All interventions produced significant hemodynamic responses compared to baseline. Both 5 Hz applications obtained higher FV increments than 1 Hz TENS (P < .001). The muscle application resulted in the lowest PV increment (P < .001). TENS at 5 Hz on nerve location was the worst tolerated, with higher values in VRS (P = .056) and VAS (P = .11), although not significant. CONCLUSION TENS at 5 Hz on soleus site may be the most appropriate protocol for enhancing venous return.
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Affiliation(s)
- Alicia Martínez-Rodríguez
- Psychosocial and Functional Rehabilitation Research Group
- Department of Physiotherapy, Medicine and Biomedical Sciences
| | | | - Isabel Raposo-Vidal
- Psychosocial and Functional Rehabilitation Research Group
- Department of Physiotherapy, Medicine and Biomedical Sciences
| | | | - Beatriz Rodríguez-Romero
- Psychosocial and Functional Rehabilitation Research Group
- Department of Physiotherapy, Medicine and Biomedical Sciences
| | - M. Amalia Jácome
- CITIC, Department of Mathematics, Faculty of Sciences, Universidade da Coruña, Campus de A Coruña, A Coruña, Spain
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Zeng Y, Zhang X, Zhou J, Wang X, Jiao R, Liu Z. Efficacy of electroacupuncture compared with transcutaneous electric nerve stimulation for functional constipation: Study protocol for a randomized, controlled trial. Medicine (Baltimore) 2018; 97:e0692. [PMID: 29742718 PMCID: PMC5959392 DOI: 10.1097/md.0000000000010692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND To treat functional constipation, both electroacupuncture (EA) therapy and transcutaneous electric nerve stimulation (TENS) are safe and effective. However, no head-to-head comparison trial has been conducted. This trial compares the efficacy of electroacupuncture relative to transcutaneous electric nerve stimulation for functional constipation. METHODS Individuals with functional constipation will be randomly allocated to receive either EA or TENS (n = 51, each), 3 times per week for 8 weeks. The primary outcome is the percentage of participants with an average increase from baseline of 1 or more complete spontaneous bowel movements at week 8. The secondary outcome measures are the following: at the time of visits, changes in the number of complete spontaneous bowel movements, number of spontaneous bowel movements, stool character, difficulty in defecation, patients' assessment of quality of life regarding constipation (self-report questionnaire), and use of auxiliary defecation methods. DISCUSSION The results of this trial should verify whether EA is more efficacious than TENS for relieving symptoms of functional constipation. The major limitation of the study is the lack of blinding of the participants and acupuncturist.
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Affiliation(s)
- Yuxiao Zeng
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- China Academy of Chinese Medical Sciences
| | - Xuecheng Zhang
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Beijing, China
| | - Jing Zhou
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- China Academy of Chinese Medical Sciences
| | - Xinwei Wang
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- Beijing University of Chinese Medicine, Beijing, China
| | - Ruimin Jiao
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- China Academy of Chinese Medical Sciences
| | - Zhishun Liu
- Department of Acupuncture, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
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Butera KA, George SZ, Borsa PA, Dover GC. Prolonged Reduction in Shoulder Strength after Transcutaneous Electrical Nerve Stimulation Treatment of Exercise-Induced Acute Muscle Pain. Pain Pract 2018; 18:954-968. [PMID: 29505689 DOI: 10.1111/papr.12690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 12/12/2022]
Abstract
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 investigated 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 analysis of variance and post-hoc analysis indicated that, compared to the control group, strength remained reduced in the TENS treatment group (48 hours post-DOMS, P < 0.05) and TENS placebo group (48 hours post-DOMS, P < 0.05; 72 hours post-DOMS, P < 0.05). 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 nonsignificant for pain. Results indicated that 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.
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Affiliation(s)
- Katie A Butera
- Department of Physical Therapy, Brooks-PHHP Research Collaboration, University of Florida, Gainesville, Florida, U.S.A
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A.,Musculoskeletal Research, Duke Clinical Research Institute, Durham, North Carolina, U.S.A
| | - Paul A Borsa
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, Florida, U.S.A
| | - Geoffrey C Dover
- Department of Exercise Science, Concordia University, Montreal, Quebec, Canada.,PERFORM Centre, Concordia University, Montreal, Quebec, Canada
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Sadala AY, Machado AFP, Liebano RE. Effects of transcutaneous electrical nerve stimulation on pain intensity during application of carboxytherapy in patients with cellulite: A randomized placebo-controlled trial. J Cosmet Dermatol 2018; 17:1175-1181. [PMID: 29337405 DOI: 10.1111/jocd.12489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Carboxytherapy may generate local pain that is considered the main limiting factor in clinical practice. Transcutaneous electric nerve stimulation (TENS) is widely used in the control of acute pain; however, the effect of TENS on pain relief during carboxytherapy has not been studied to date. AIMS To assess the effect of TENS on pain intensity during carboxytherapy in patients with cellulite in the gluteal region. PATIENTS/METHODS This randomized clinical trial was conducted with 84 patients, 18-44 years of age, who had moderate cellulite in the gluteal region, according to Cellulite Severity Scale, but never received carboxytherapy. Patients were randomized into 3 groups: active TENS, placebo TENS, and control group. For the intervention, skin depressions with cellulite were outlined, and the gluteal area to be treated was defined. The subcutaneous injection of CO2 was performed using 0.30 × 13 mm-needles at a 45° angle, with a controlled flow rate of 100 mL/min maintained for 1 minute at each puncture site. The parameters for TENS were as follows: frequency of 100 Hz and pulse duration of 200 μs; TENS intensity was adjusted until the patient reported strong paresthesia. The visual numeric pain rating scale was used to assess pain intensity after each puncture. RESULTS The active TENS group reported lower pain intensity compared to the placebo TENS (P < .0001) and control (P < .0001) groups. CONCLUSIONS Transcutaneous electric nerve stimulation (TENS) was effective in reducing pain intensity during carboxytherapy in patients with cellulite in the gluteal region.
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Affiliation(s)
- Adria Y Sadala
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brasil
| | - Aline F P Machado
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brasil
| | - Richard E Liebano
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brasil.,Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil
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50
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Khan AA, Srivastava A, Passi D, Devi M, Chandra L, Atri M. Management of myofascial pain dysfunction syndrome with meditation and yoga: Healing through natural therapy. Natl J Maxillofac Surg 2018; 9:155-159. [PMID: 30546229 PMCID: PMC6251288 DOI: 10.4103/njms.njms_25_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aims and Objectives: Aims and objectives of the study were to study the effectiveness of Raj-yoga meditation and pranayama in patients with myofascial pain dysfunction syndrome (MPDS) and compared the effects with ongoing conventional noninvasive treatment modalities. Materials and Methods: The study comprised 30 patients divided equally (10 each) into 3 group, i.e., control group (conventional, noninvasive treatment), Experimental A group (conventional, noninvasive treatment with raj-yoga meditation therapy and pranayama), and Experimental B group (Raj-yoga meditation therapy and pranayama only). Parameters such as pain, mouth opening, mandibular deviation, inflammation, swelling, clicking, occlusion, and psychologic evaluation such as anxiety, stress, and depression were assessed before the start of the study and at weekly intervals for 3 months. Results: Posttreatment pain and inflammation improved both in the control group and Experimental A group, but statistically it is highly significant in the Experimental A group. Furthermore, it is effective immediately as well as for a long period in Experimental A group. Improvement in mouth opening was statistically highly significant in control group but not in the experimental groups. Posttreatment anxiety and stress status was improved with statistically highly significant result in the Experimental A and B. The posttreatment depression status along with mandibular deviation, swelling, clicking, and occlusion has not improved significantly in any of the groups. Interpretation and Conclusion: Raj-yoga meditation and pranayama in combination with conventional, noninvasive, treatment modalities showed promising results in MPDS patients as compared to either modalities alone.
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Affiliation(s)
- Abdul Ahad Khan
- Department of Oral and Maxillofacial Surgery, King Khalid University, College of Dentistry, Saudi Arabia
| | - Anchal Srivastava
- Department of Oral Pathology, Government Medical College, Aurangabad, Maharashtra, India
| | - Deepak Passi
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, Delhi, India
| | - Manisha Devi
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, Delhi, India
| | - Lokesh Chandra
- Department of Oral and Maxillofacial Surgery, ESIC Dental College and Hospital, Rohini, Delhi, India
| | - Mansi Atri
- Department of Public Health Dentistry, ESIC Dental College and Hospital, Rohini, Delhi, India
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