Transcutaneous Electrical Nerve Stimulation

Purpose To investigate the effects of a physiotherapy program on incision pain and functional activities in the early post-cesarean period. Methods Fifty women were evaluated after Cesarean operation with regard to times of ambulation and return of bowel activity, intensity of incision pain, difficulty in functional activities and number of analgesics required additional to routine pain control procedure. Twenty-four women received only routine nursing care, and a physiotherapy program was applied to the study group (n = 26), additionally. Results Postoperative ambulation and return of bowel activity were earlier in the study group (p < 0.05). Incision pain and difficulty in functional activities decreased significantly within 2 days in both groups, and the values were lower in the study group (p < 0.05). Study group needed less medication for pain control (p < 0.05). Conclusions Findings revealed the effectiveness of a physiotherapy program in the early post-cesarean period in a wider perspective than the current literature, and are considered to be valuable for increasing the quality and productivity of the postnatal care, therefore improving well-being after childbirth.

Management strategies in myofascial pain syndrome are summarized and most of the conservative therapeutic techniques for myofascial trigger points are briefly described. These can be classified as manual or instrumental. It is concluded that more high quality research is needed to allow for a higher level of scientific evidence regarding the efficacy of techniques.

to examine effectiveness and overall opiate consumption between high-sensory transcutaneous electrical nerve stimulation (Hi-TENS) combined with patient-controlled analgesia with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth. randomised, controlled study. a county hospital in south-west Sweden. 42 multiparous women. participants were randomly assigned and connected to patient-controlled analgesia with morphine alone or in combination with Hi-TENS apparatus. Levels of morphine consumed were calculated every third hour during the first 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption of morphine differed significantly between the groups: morphine with TENS was 16.2 ± 12.6 mg and morphine alone was 33.1 ± 20.9 mg (p = 0.007). Assessment of pain relief showed no significant difference. Sedation differed significantly between the groups (p = 0.045), especially between three and 12 hours post partum (p = 0.011). pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed benefit of this treatment combination is that the mother is more alert and better able to interact with her newborn during the first hours after birth without drowsiness due to large doses of opiates.

The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of The Spine Journal, titled Evidence Informed Management of Chronic Low Back Pain Without Surgery. Articles in this special focus issue were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidenc...

Background and Purpose. It is not fully understood how transcutaneous electrical nerve stimulation (TENS) intensity affects mechanical pain threshold. Method. Sixty-six healthy volunteers (13 male, 53 female; 132 hands) without prior experience of TENS participated in the study, which comprised a randomized single-blind controlled trial. TENS was administered for 20 minutes through electrodes (25 × 25 mm) placed on the hands and forearms with a fixed frequency of 100 Hz and pulse duration of 150 µs. TENS intensity was randomized and allocated in a concealed manner so that one arm received TENS with stimulation intensity set at participants' subjective sensory threshold and the other received TENS with stimulation intensity continuously adjusted by physiotherapists to a strong but comfortable non-painful stimulation. Observers were blinded to stimulation intensity levels. Results. Mechanical pain threshold increased significantly, by a mean total of 0.79 kg/cm2 (95% confidence interval [95% CI]: 0.54–1.04) (p < 0.001) on the strong but comfortable non-painful stimulation side. The mean change in mechanical pain threshold on the sensory threshold side was 0.19 kg/cm2 and did not reach statistical significance (95% CI–0.15 to 0.51). The mean stimulation intensity level for sensory threshold was 6.7 mA (95% CI: 5.65 to 7.83) which was significantly lower (p < 0.001) than the mean stimulation intensity for the strong stimulation, which was 20.5 mA (95% CI 16.6 to 24.4), respectively. The strong stimulation levels were, on average, 3.05 times higher than sensory threshold, but individual variations were large (range 1.2–6.1). Conclusions. TENS administered at a strong but comfortable non-painful stimulation intensity increases mechanical pain threshold ipsi-laterally in healthy subjects, whereas TENS administered at sensory threshold intensity does not. TENS may be ineffective if electrodes are placed contralaterally or distant to the pain site and if stimulation intensity levels are not titrated to subjective strong levels. Further clinical trials are needed to clarify if these findings may also be generalized to populations of chronic pain sufferers. Copyright © 2007 John Wiley & Sons, Ltd.

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic treatment for pain relief. TENS has been used to treat a variety of painful conditions. This review updates the basic and clinical science regarding the use of TENS that has been published in the past 3 years (ie, 2005–2008). Basic science studies using animal models of inflammation show changes in the peripheral nervous system, as well as in the spinal cord and descending inhibitory pathways, in response to TENS. Translational studies show mechanisms to prevent analgesic tolerance to repeated application of TENS. This review also highlights data from recent randomized, placebo-controlled trials and current systematic reviews. Clinical trials suggest that adequate dosing, particularly intensity, is critical to obtaining pain relief with TENS. Thus, evidence continues to emerge from both basic science and clinical trials supporting the use of TENS for the treatment of a variety of painful conditions while identifying strategies to increase TENS effectiveness.

As a prelude to developing updated, evidence-based, international consensus recommendations for the management of hip and knee osteoarthritis (OA), the Osteoarthritis Research Society International (OARSI) Treatment Guidelines Committee undertook a critical appraisal of published guidelines and a systematic review (SR) of more recent evidence for relevant therapies.Sixteen experts from four medical disciplines (primary care two, rheumatology 11, orthopaedics one and evidence-based medicine two), two continents and six countries (USA, UK, France, Netherlands, Sweden and Canada) formed the guidelines development team. Three additional experts were invited to take part in the critical appraisal of existing guidelines in languages other than English. MEDLINE, EMBASE, Science Citation Index, CINAHL, AMED, Cochrane Library, seven Guidelines Websites and Google were searched systematically to identify guidelines for the management of hip and/or knee OA. Guidelines which met the inclusion/exclusion criteria were assigned to four groups of four appraisers. The quality of the guidelines was assessed using the AGREE (Appraisal of Guidelines for Research and Evaluation) instrument and standardised percent scores (0–100%) for scope, stakeholder involvement, rigour, clarity, applicability and editorial independence, as well as overall quality, were calculated. Treatment modalities addressed and recommended by the guidelines were summarised. Agreement (%) was estimated and the best level of evidence to support each recommendation was extracted. Evidence for each treatment modality was updated from the date of the last SR in January 2002 to January 2006. The quality of evidence was evaluated using the Oxman and Guyatt, and Jadad scales for SRs and randomised controlled trials (RCTs), respectively. Where possible, effect size (ES), number needed to treat, relative risk (RR) or odds ratio and cost per quality-adjusted life year gained (QALY) were estimated.Twenty-three of 1462 guidelines or consensus statements retrieved from the literature search met the inclusion/exclusion criteria. Six were predominantly based on expert opinion, five were primarily evidence based and 12 were based on both. Overall quality scores were 28%, 41% and 51% for opinion-based, evidence-based and hybrid guidelines, respectively (P = 0.001). Scores for aspects of quality varied from 18% for applicability to 67% for scope. Thirteen guidelines had been developed for specific care settings including five for primary care (e.g., Prodigy Guidance), three for rheumatology (e.g., European League against Rheumatism recommendations), three for physiotherapy (e.g., Dutch clinical practice guidelines for physical therapy) and two for orthopaedics (e.g., National Institutes of Health consensus guidelines), whereas 10 did not specify the target users (e.g., Ontario guidelines for optimal therapy). Whilst 14 guidelines did not separate hip and knee, eight were specific for knee but only one for hip. Fifty-one different treatment modalities were addressed by these guidelines, but only 20 were universally recommended. Evidence to support these modalities ranged from Ia (meta-analysis/SR of RCTs) to IV (expert opinion). The efficacy of some modalities of therapy was confirmed by the results of RCTs published between January 2002 and 2006. These included exercise (strengthening ES 0.32, 95% confidence interval (CI) 0.23, 0.42, aerobic ES 0.52, 95% CI 0.34, 0.70 and water-based ES 0.25, 95% CI 0.02, 0.47) and nonsteroidal anti-inflammatory drugs (NSAIDs) (ES 0.32, 95% CI 0.24, 0.39). Examples of other treatment modalities where recent trials failed to confirm efficacy included ultrasound (ES 0.06, 95% CI −0.39, 0.52), massage (ES 0.10, 95% CI −0.23, 0.43) and heat/ice therapy (ES 0.69, 95% CI −0.07, 1.45). The updated evidence on adverse effects also varied from treatment to treatment. For example, while the evidence for gastrointestinal (GI) toxicity of non-selective NSAIDs (RR = 5.36, 95% CI 1.79, 16.10) and for increased risk of myocardial infarction associated with rofecoxib (RR = 2.24, 95% CI 1.24, 4.02) were reinforced, evidence for other potential drug related adverse events such as GI toxicity with acetaminophen or myocardial infarction with celecoxib remained inconclusive.Twenty-three guidelines have been developed for the treatment of hip and/or knee OA, based on opinion alone, research evidence or both. Twenty of 51 modalities of therapy are universally recommended by these guidelines. Although this suggests that a core set of recommendations for treatment exists, critical appraisal shows that the overall quality of existing guidelines is sub-optimal, and consensus recommendations are not always supported by the best available evidence. Guidelines of optimal quality are most likely to be achieved by combining research evidence with expert consensus and by paying due attention to issues such as editorial independence, stakeholder involvement and applicability. This review of existing guidelines provides support for the development of new guidelines cognisant of the limitations in existing guidelines. Recommendations should be revised regularly following SR of new research evidence as this becomes available.

Drop foot syndrome is general term for difficulty lifting the front part of the foot from the ground which is a common problem that can lead to falls, trips and injuries in human life. It is usually neuromuscular disorder that causes peroneal neuropathy between the neck and the fibula. In other words drop foot problem is the loss of communication between the peroneal nerve and central nervous system which is enables the foot to make dorsiflexion. The patient cannot move his/her foot upward the ankle or toes. Foot drop correction is generally achieved by electric stimulation of the common peroneal nerve by sending a series of pulses at a given amplitude, duration and frequency. For this purpose a programmable microcontroller based stimulation, low-power, low-cost, battery operated, high performance and portable electronic stimulation device has been developed. The stimulator has been designed to make correction on the foot drop syndrome, which is called FES device. In the traditional FES systems, sensors are placed inside the shoe sole which are connected to a stimulator device using lead wires. The system designed by using Radio Frequency (RF) transmitter/receiver pair to connect the sensors to the stimulator device. For this reason, the patients can use this device more comfortably, and easier. In the design of the FES device, a force sensitive sensor, programmable microcontroller, transmitter, receiver and electrodes are used. Stimulation amplitude, duty cycle, and frequency of the output waveform can easily be adjusted by using switches. Also design has been developed further by the addition of another second in-sole foot sensor underneath the metatarsal heads so that device enabled reliable sensing in addition to walking on straight surfaces during the stair climbing. The cost of the overall system is very low, because during the development process standard microcontroller development systems and standard electronic equipment's were used which are easily found in the market.

Purpose To investigate the effects of a physiotherapy program on incision pain and functional activities in the early post-cesarean period. Methods Fifty women were evaluated after Cesarean operation with regard to times of ambulation and return of bowel activity, intensity of incision pain, difficulty in functional activities and number of analgesics required additional to routine pain control procedure. Twenty-four women received only routine nursing care, and a physiotherapy program was applied to the study group (n = 26), additionally. Results Postoperative ambulation and return of bowel activity were earlier in the study group (p < 0.05). Incision pain and difficulty in functional activities decreased significantly within 2 days in both groups, and the values were lower in the study group (p < 0.05). Study group needed less medication for pain control (p < 0.05). Conclusions Findings revealed the effectiveness of a physiotherapy program in the early post-cesarean period in a wider perspective than the current literature, and are considered to be valuable for increasing the quality and productivity of the postnatal care, therefore improving well-being after childbirth.

The electrode serves as the critical component of Functional Electrical Stimulation, Brain Machine Interfaces and Neural Prosthesis.  The choice of electrode use in any stimulation system would depend on the application. In this Review, we examine various types of electrodes and analyze their sensitivity, invasiveness, reproducibility and effectiveness.

Purpose To investigate the effects of a physiotherapy program on incision pain and functional activities in the early post-cesarean period. Methods Fifty women were evaluated after Cesarean operation with regard to times of ambulation and return of bowel activity, intensity of incision pain, difficulty in functional activities and number of analgesics required additional to routine pain control procedure. Twenty-four women received only routine nursing care, and a physiotherapy program was applied to the study group (n = 26), additionally. Results Postoperative ambulation and return of bowel activity were earlier in the study group (p &lt; 0.05). Incision pain and difficulty in functional activities decreased significantly within 2 days in both groups, and the values were lower in the study group (p &lt; 0.05). Study group needed less medication for pain control (p &lt; 0.05). Conclusions Findings revealed the effectiveness of a physiotherapy program in the early post-cesarean perio...

Background: studies indicate correlation between dysphonia and muscle tension. Aim: to evaluate bilaterally the electrical activity of the suprahyoid muscles (SH), sternocleidomastoid (SCM), and trapezius (T), the presence of pain and the voice, after applying transcutaneous electrical nerve stimulation (TENS). Method: ten (10) women with nodules or bilateral mucus thickening, and phonation fissure. Volunteers were submitted to 10 TENS sessions

Sixty patients aged 15 to 40 years of either sex, American Society of Anaesthesiologists (ASA) grade I and II, undergoing tonsillectomy, were randomly allocated to receive either preroperative intramuscular diclofenac sodium(group A) or pre- incisional bilateral infiltration of bupivacaine in the peritonsillar fossa (group B) or post operative Trunscutaneous Electric Nerve Stimulation - TENS (group C) at fixed time intervals. Pain scores (Visual analogue scale VAS, 0- 100 mm) were assessed at rest and on deglutition at 1,3,6,9,12 and 24 hours after surgery. Pentazocine 1actale 15 mg IV was given as rescue analgesic whenever VAS estimation was more than 30 mm at rest (not deglutition). Constant incisional pain was significantly less ( p &lt; 0.01 ANOVA) in group C after 3 hours of surgery as compared to group A and B. Similarly pain on deglutition was significantly less (p &lt;0.01, ANOVA) in group C during the entire study period as compared to Group A and B. There was significant r...

Objective: To compare and assess the immediate analgesic effects of conventional and burst transcutaneous electrical nerve stimulation in patients with chronic low back pain. Methods: We conducted a three-arm single-blinded randomized controlled trial. A total of 105 patients with non-specific chronic low back pain aged between 18 and 85 years were randomly assigned into the following groups: Placebo Group (sham electrical stimulation), Conventional TENS Group (continuous stimulation at 100Hz for 100µs with sensory intensity), and Burst TENS Group (stimulation at 100Hz modulated at 2Hz for 100µs with motor-level intensity). All groups received a single application of transcutaneous electrical nerve stimulation for 30 minutes. The outcomes, namely, pain intensity, quality of pain, and pressure pain threshold were measured by the visual analog scale, McGill pain questionnaire, and algometry, respectively. The patients were evaluated before and immediately after the transcutaneous electrical nerve stimulation application. Results: Pain intensity (visual analog scale score) and quality of pain (McGill pain questionnaire score) significantly decreased (p<0.05) in Intervention Groups (Conventional TENS Group and Burst TENS Group). A positive effect was observed in the interventions compared to the Placebo Group in all domains of the McGill pain questionnaire (p<0.05), excepting for the pain intensity. Pressure pain threshold significantly increased (p<0.05) immediately after the transcutaneous electrical nerve stimulation application in both Intervention Groups, but not in the Placebo Group. For significant difference was found during assessment when comparing both Intervetion Group. Conclusion: Both transcutaneous electrical nerve stimulation modes were effective for pain modulation. Moreover, there was an increase in the pressure pain threshold. No significant results were found to indicate the best mode for the treatment of chronic low back pain.

Dystocia means abnormal / difficult birth and can develop because of the mother or the offspring. Cesarean section is stated in cases of dystocia and is commonly performed in dogs and cats. Especially in miniature and small breed dogs, dystocia has a high incidence of 59.4%.
Postnatal and postoperative acute pain at the incision site after a cesarean. While stressing cortisol level increases, it delays oxytocin release, which plays a role in lowering milk and maternal behavior development. Information on the safety of analgesics applied for postoperative pain after cesarean section and its effect on newborns is also quite insufficient.
In dogs; abnormal maternal behaviors such as aggression, cannibalism, pup rejection, and pseudocyesis can be seen due to high cortisol, hereditary predisposition, low serotonin, and low oxytocin levels. Among the reasons listed, there is a close relationship between cortisol and oxytocin. Oxytocin is an anxiolytic effective anti-stress hormone that suppresses the release of cortisol triggered by stress. In the release of cortisol, the hypothalamic-pituitary-adrenal axis is used, while oxytocin is released as a neurohypophyseal hormone. Both hormones show neurophysiological effects.
Pharmacological and non-pharmacological methods are used to relieve postoperative pain after cesarean section in humans. Non-pharmacological techniques; are divided into 2 as cognitive / behavioral techniques and physical techniques. Physical techniques that include treatments such as transcutaneous nerve stimulation (TENS), acupuncture, acupressure, massage, aromatherapy, homeopathy, reflexology are considered more practical in terms of veterinary medicine use. Among the non-pharmacological physical techniques, TENS; is an easy, cheap, noninvasive analgesic method that is frequently used in pain control. TENS increases the release of endorphins after cesarean section, provides local vasodilation in painful areas, and decreases pain by stimulating acupuncture points.
Another non-pharmacological technique is aromatherapy. Aromatherapy; by distilling aromatic essential oils found in various plants; is phytotherapy used in the treatment of pain, anxiety, depression, insomnia, and fatigue. It is stated that essential oils act on the limbic system and hypothalamus through the tractus olfactorius. There are also studies suggesting that lavender aromatherapy increases oxytocin secretion.
Based on these data, TENS and aromatherapy (lavender) treatments to be applied after cesarean section in dogs; it will reduce pain stress with a complementary effect to pharmacological analgesics in the relief of postoperative pain, reduce the cortisol level, and provide earlier release of oxytocin, which is delayed by pain stress and anesthesia effect.
We have planned a study on the effect of blood pressure, body temperature, saturation, respiratory rate, heart rate, salivary oxytocin, and salivary cortisol levels which TENS and aromatherapy treatments applied after cesarean in dogs.
It is aimed to collect data noninvasively. The research will be done with pet veterinary clinics. The cesarean operation will be performed by the responsible veterinarian in the clinic. The first hour after cesarean, the researcher will apply TENS and / or aromatherapy, and physiological values and behaviors will be recorded during this process. The research; is planned on 20 female dogs (miniature and small breeds) divided into 4 groups (control, TENS, aromatherapy, and TENS+aromatherapy).
Blood pressure, body temperature, saturation, respiratory and cardiac measurements will be made noninvasively in the first hour after cesarean.
Saliva samples will be collected from all animals before, after cesarean, and at the end of the treatment. Samples will be analyzed by ELISA (Enzyme-Linked Immunosorbent Assay).
In the camera records taken within the first hour after a cesarean; mothers’ and offspring's behaviors will be examined and scored.
The study will be calculated by multiple regression analyzes whether there are cortisol level changes, oxytocin level changes, physiological and behavioral changes, and whether these are related to each other in the first hour after cesarean section.
At the end of the study; it is expected that transcutaneous electrical neuron stimulation and aromatherapy will cause a decrease in cortisol level and an increase in oxytocin level in dogs after cesarean section.

Introduction: Pain control is the most important issue in emergency department management of patients with femoral bone fractures. The present study aimed to compare the procedural features of ultrasonography and nerve stimulator guided femoral nerve block in this regard. Methods: In this randomized clinical trial, patients with proximal femoral fractures presenting to emergency department were randomly divided into two groups of ultrasonography or nerve stimulator guided femoral block and compared regarding success rate, procedural time, block time, and need for rescue doses of morphine sulfate, using SPSS 20. Results: 50 patients were randomly divided into two groups of 25 (60% male). The mean age of studied patients was 35.14 ± 12.95 years (19 – 69). The two groups were similar regarding age (p= 0.788), sex (p = 0.564), and initial pain severity (p = 0.513). In 2 cases of nerve stimulator guided block, loss of pinprick sensation did not happen within 30 minutes of injection (success rate: 92%; p = 0.490). Ultrasonography guided nerve block cases had significantly lower procedural time (8.06 ± 1.92 vs 13.60 ± 4.56 minutes; p < 0.001) and lower need for rescue doses of opioid (2.68 ± 0.74 vs 5.28 ± 1.88 minutes; p < 0.001). Conclusion: Ultrasonography and nerve stimulator guided femoral block had the same success rate and block duration. However, the ultrasonography guided group had lower procedure time and lower need for rescue doses of morphine sulfate. Therefore, ultrasonography guided femoral block could be considered as an available, safe, rapid, and efficient method for pain management of femoral fracture in emergency department.

Our aim was to compare rectal perception of patients with diarrhea-predominant irritable bowel syndrome (IBS-D), constipation-predominant irritable bowel syndrome (IBS-C), functional constipation (FC), and healthy controls and to evaluate the therapeutic effect of acupoint transcutaneous electric nerve stimulation (TENS). Age- and sex-matched patients (24 IBS-D, 20 IBS-C, and 30 FC) were selected, and 30 volunteers served as healthy controls. Rectal sensory thresholds were evaluated by rectal balloon distension. Short- and long-term acupoint TENS was given respectively. IBS-D patients had significantly lower rectal sensory thresholds of the first sensation of stool, urgency of defecation, and pain than IBS-C or FC patients or healthy controls (P <0.05), but there were no differences in rectal sensory thresholds among IBS-C and FC patients and healthy controls. In each group, females had significantly lower rectal sensory thresholds than males (P <0.05), but there was no difference between younger (≤50 years old) and older (>50 years old) patients. Short-term acupoint TENS increased rectal sensory thresholds of IBS-D patients. After 2-month acupoint TENS treatment in IBS-D patients, rectal sensory thresholds were significantly increased, stool times and the intensity of abdominal pain were decreased, and psychological scores were relieved to normal. Lowered rectal perception threshold is a hallmark of IBS-D patients. Females have significantly lower rectal sensory thresholds than males. Acupoint TENS is effective to treat IBS-D.