Transcutaneous Electrical Nerve Stimulation In Combination Research Articles

The clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain: a protocol for a meta-analysis of randomised controlled trials (RCTs)

IntroductionThe aim of this systematic review with meta-analysis is to evaluate the clinical efficacy of transcutaneous electrical nerve stimulation (TENS) for any type of acute and chronic pain in adults.Methods...

Efficacy of transcutaneous electrical nerve stimulation combined with therapeutic exercise on hand function in children with hemiplegic cerebral palsy

Purpose: Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological method used to reduce spasticity. It was also assumed that TENS reduces pain and therefore improves limb function. Most of the previous studies about the effect of TENS were done in the lower limb and in stroke patients. There is a lack of enough literature about the direct and indirect effects of TENS in the upper limb. Hence, our study aimed to determine whether TENS combined with therapeutic exercises helps to improves hand function by reducing spasticity in children with hemiplegic cerebral palsy (CP).Materials and methods: Twenty-nine children with hemiplegic CP were randomly assigned to the TENS group (n = 15) or the control group (n = 14). The TENS group received traditional physical therapy with the adjunct application of conventional TENS for 30 minutes (pulse duration, 250 µs; pulse rate, 100 Hz) on the wrist extensors, once daily, 3 days a week, for 8 weeks, while the control group received traditional physical therapy.Results: The results showed a significant intergroup difference in handgrip strength over the 8-week period. The time to accomplish the Jebsen Taylor Hand Function Test (JTHFT) task decreased by 48% and the ABILHAND-Kids questionnaire scores improved by 23% in the TENS group.Conclusions: The use of TENS in combination with therapeutic exercise may improve strength and hand function.

Ultrasound combined transcutaneous electrical nerve stimulation (UltraTENS) versus phonophoresis of piroxicam (PhP) in symptomatic knee osteoarthritis: A randomized double-blind, controlled trial.

Ultrasound combined with transcutaneous electrical nerve stimulation (UltraTENS) and phonophoresis of piroxicam (PhP) are combined modality therapy that frequently used in musculoskeletal pain including knee osteoarthritis (OA). But it is lack of a good clinical trial to prove and compare their effects. To compare the effects of UltraTENS with PhP on mild to moderate degree of symptomatic knee OA. Sixty-one patients (55 women), mean age of 63.4 ± 8.1 y, 50-90 mm VAS of knee pain and Kellgren-Lawrence score of grade I-III were randomly allocated into UltraTENS and PhP (N = 31 and 30, respectively). The UltraTENS group received a combined ultrasound with TENS program and a non-drug gel, whereas the PhP group got an ultrasound program with piroxicam gel and sham TENS. All patients were treated for a total of 10 sessions, consisting of five times per week and 10 min per session. Before and after treatment, patients were evaluated knee pain by using the 100-mm VAS and functional performance by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. The UltraTENS and PhP groups experienced considerable improvement in both VAS and total WOMAC scores post-treatment (P< 0.001). The PhP had better VAS of pain and WOMAC scores but no statistical significance. Results show that UltraTENS and PhP were effective for relieving pain and improve functionality knee OA without significant differences between their effects.

The combined effects of transcutaneous electrical nerve stimulation (TENS) and stretching on muscle hardness and pressure pain threshold.

[Purpose] This study aimed to clarify the immediate effects of a combined transcutaneous electrical nerve stimulation and stretching protocol. [Subjects] Fifteen healthy young males volunteered to participate in this study. The inclusion criterion was a straight leg raising range of motion of less than 70 degrees. [Methods] Subjects performed two protocols: 1) stretching (S group) of the medial hamstrings, and 2) tanscutaneous electrical nerve stimulation (100 Hz) with stretching (TS group). The TS group included a 20-minute electrical stimulation period followed by 10 minutes of stretching. The S group performed 10 minutes of stretching. Muscle hardness, pressure pain threshold, and straight leg raising range of motion were analyzed to evaluate the effects. The data were collected before transcutaneous electrical nerve stimulation (T1), before stretching (T2), immediately after stretching (T3), and 10 minutes after stretching (T4). [Results] Combined transcutaneous electrical nerve stimulation and stretching had significantly beneficial effects on muscle hardness, pressure pain threshold, and straight leg raising range of motion at T2, T3, and T4 compared with T1. [Conclusion] These results support the belief that transcutaneous electrical nerve stimulation combined with stretching is effective in reducing pain and decreasing muscle hardness, thus increasing range of motion.

Combined effects of transcutaneous electrical nerve stimulation and stretching

Background: Transcutaneous Electrical Nerve Stimulation (TENS) has an influence on the pain inhibitory mechanism. TENS is believed to influence pain threshold levels via gate control theory, endogenous anesthesia theory, and local nerve block. Although TENS is reported to be effective when used in combination with other therapeutic exercises, the combined effects are still conflicted. Purpose: The purpose of this study is to clarify the effects of TENS in combination with stretching on pressure pain threshold (PPT), muscle hardness (MH) and range of motion (ROM) of straight leg raising (SLR) in healthy individuals. Methods: 11 healthy males (age 18–26 years old, height 168.8± 4.7 cm, weight 67.8± 13.7 kg) with no self-reported musculoskeletal disorders and neurological symptoms volunteered to participate in this study. An inclusive criterion is that the ROM of SLR is less than 70 degrees. Subjectswere randomly assigned and all participated in all of the three groups; stretching exercise (S group), TENS treatment followed by stretching (TS group), and simultaneously combined TENS and stretching (CTS group). Prior to experiment, subjects had a 10minute rested for all protocols. S group performed a stretching exercise and the exercise was done at 90% of maximum SLR range for 30 seconds followed by 30 second rest, and repeated 10 times for 10minutes. In the TS group, the stretching was done just after TENS (biphasic symmetry pulse, pulse width 200 s, frequency 100Hz, 80% of pain threshold) was applied over the medial hamstrings for 20minutes. The protocol for the CTS group was 20minutes of applied TENS, with the final 10minutes combined with the stretching exercise. Three evaluations were used for analysis; PPT, MH and range of SLR. The data were collected before TENS (T1), before stretching (T2), and for immediately after stretching and 10minutes post-stretching (T3 and T4 respectively). Results: TS and CTS groups showed significant difference inPPT,MHand rangeofSLRatT2,T3 andT4compared to T1 (p< 0.01). Regarding a comparison of S group (a difference between T2-3), and TS or CTS groups (a difference between T1-3), all PPT, MH and range of SLR in TS and CTS groups had a significant effect compared to S group (p< 0.01). Conclusion(s): These results support the use of TENS in combination with stretching, i.e. stretching after TENS or stretching during TENS, to reduce pain and increase muscle flexibility, and thus increase the joint range of motion. Since CTS group had the same effect with T S group, the TS protocol would be more time efficient while maintaining the effects of TENS. Implications: Further research is required to determine if TENS is beneficial to older and less physically able patients. For young physically unimpaired subjects the benefits are clear.

Does the use of TENS increase the effectiveness of exercise for improving walking after stroke? A randomized controlled clinical trial

Objective: To investigate whether surface electrical stimulation can increase the effectiveness of task-related exercises for improving the walking capacity of patients with chronic stroke. Design: Randomized, placebo-controlled clinical trial. Setting: Home-based programme. Subjects: One hundred and nine hemiparetic stroke survivors were assigned randomly to: (1) transcutaneous electrical nerve stimulation (TENS), (2) TENS + exercise, (3) placebo stimulation + exercise, or (4) control group. Interventions: The TENS group received 60 minutes of electrical stimulation. Both the TENS + exercise group and placebo stimulation + exercise group did 60 minutes of exercises, followed respectively by 60 minutes of electrical and placebo stimulation. Treatment was given five days a week for four weeks. The control group had no active treatment. Outcome measures: Comfortable gait speed was measured using a GAITRite II walkway system. Walking endurance and functional mobility were measured by the distance covered during a 6-minute walk test (6MWT) and by timed up and go test scores before treatment, after two weeks and after four weeks of treatment, and at follow-up four weeks after treatment ended. Results: When compared with the other three groups, only the combined TENS + exercise group showed significantly greater absolute and percentage increases in gait velocity (by 37.1—57.5%, all P<0.01) and reduction in timed up and go scores (by —14.9 to —23.3%, P<0.01) from week 2 onwards. When compared with the control and TENS groups, only the combined TENS + exercise group covered significantly more distance in the 6MWT (by 22.2—34.7%, P<0.01) from week 2 onwards. Conclusion: TENS can improve the effectiveness of task-related exercise for increasing walking capacity in hemiparetic stroke survivors.

High and Low Frequency TENS Reduce Postoperative Pain Intensity After Laparoscopic Tubal Ligation

Transcutaneous electrical nerve stimulation (TENS) is an effective adjunctive therapy for postoperative pain; however, effects of different frequencies of stimulation have not been systematically investigated. Laparoscopic sterilization (LS) causes significant pain in the early postoperative period and requires substantial postoperative medication. Therefore, we studied the effects of TENS on postoperative pain after LS through placement of Yoon fallopian rings in a prospective, randomized, double-blinded, and placebo-controlled study.Sixty-four patients undergoing LS for uterine tube ligation were randomly allocated to receive either active TENS or placebo TENS. Postoperative pain was evaluated using a standard 11-point numeric rating scale and the McGill Pain Questionnaire (MPQ)-pain rating index and number of words chosen. Both high frequency (100 Hz) and low frequency (4 Hz) TENS, at strong, but comfortable sensory intensity, were applied for 20 minutes through 4 electrodes placed around the surgical incision immediately after surgery. Pain was assessed before and after application of TENS when patients were at postanesthesia care unit (PACU).Both high and low frequency TENS significantly decreased postoperative pain intensity when compared with before administration of TENS using the numeric rating scale (P=0.001), pain rating index (P=0.001), and number of words chosen (P=0.001) compared with placebo TENS (P=0.001). TENS in combination with standard pharmacologic analgesic treatment was efficacious for postoperative pain relief after LS.We recommend regular use of multimodal therapy with TENS and analgesic drugs after LS with placement of Yoon rings.

Systemic morphine in combination with TENS produces an increased antihyperalgesia in rats with acute inflammation

Given that transcutaneous electrical nerve stimulation (TENS) achieves its anti-hyperalgesia through endogenous opioid receptors, this study was undertaken to assess if TENS in combination with morphine was more effective at reducing primary hyperalgesia. Acute inflammation was induced by subcutaneous injection of 3% carrageenan into the rat's hindpaw. The withdrawal latency to heat and the mechanical withdrawal threshold were assessed before and after inflammation and after treatment with TENS (high- or low-frequency). Animals were divided into the following groups: Group 1, saline, no TENS; Group 2, high- or low-frequency TENS plus saline; Group 3, morphine (0.3, 1, and 3 mg/kg, intraperitoneal [IP]), no TENS; and Group 4, high- or low-frequency TENS plus morphine (0.3, 1, and 3 mg/kg, IP). There was an increase in inhibition of primary heat but not mechanical hyperalgesia after treatment with either high- or low-frequency TENS in combination with morphine. In combination with morphine, low-frequency TENS produced a similar reduction in mechanical hyperalgesia when compared with morphine alone. High-frequency TENS in combination with morphine produced a similar reduction in mechanical hyperalgesia when compared with the effects of high-frequency TENS alone. Thus, a lower dose of morphine could be used in combination with TENS to decrease the side effects of systemic morphine and achieve the same degree of analgesia.