Conventional Transcutaneous Electrical Nerve Stimulation Research Articles

Effect of strengthening exercises in individuals with patellofemoral pain syndrome: a randomised controlled trial

Background/Aims Muscle imbalance in patella stabilisers leads to patellar lateral glide and can cause patellofemoral pain syndrome. This study investigated the effect of progressive strengthening exercises of the vastus medialis oblique on pain and patellar alignment in patients with patellofemoral pain syndrome and patellar lateral glide. Methods A double-blind, randomised controlled trial was conducted with 40 individuals with patellofemoral pain syndrome with patellar lateral glide aged 20–40 years. The study group received vastus medialis oblique-specific strengthening exercises and routine physiotherapy treatment, and the control group received routine physiotherapy treatment only (stretching exercises, gluteal and quadriceps isometric exercises and conventional transcutaneous electrical nerve stimulation). Participants performed these exercises three times a week for 8 weeks. Pain intensity was measured before and after the intervention using a visual analogue scale and patellar alignment was measured using ultrasonographic parameters, including the trochlear angle, patella offset angle and distance between patellar tip and trochlear groove. Results In the between-groups comparison, there was a significant decrease in pain intensity in both the study and control groups, although the study group had a greater decrease (study group before intervention: 71.15 ± 1.54, study group after intervention: 22.21 ± 0.35, P=0.001); control group before intervention: 70.09 ± 1.22, control group after intervention: 31.82 ± 0.36 (P=0.001)) and patella offset angle (in the study group compared to the control group after 8 weeks of intervention. In within-groups comparison, a significant decrease of the patella offset angle in the study group was observed (before intervention: 16.2 ± 1.53; after intervention: 13.2 ± 1.87, P=0.001). No significant differences were found for the other parameters. Conclusions Specific strengthening of the vastus medialis oblique muscle in patients with patellofemoral pain syndrome and patellar lateral glide can lead to pain reduction and improvement of patellar alignment to correct lateralisation. This change may delay the process of patellofemoral joint degeneration. Including vastus medialis oblique-specific strengthening exercises in standard physiotherapy treatments may help to reduce pain levels in people with patellofemoral pain syndrome. Implications for practice Investigating the main cause of patellofemoral pain syndrome could have an essential role in the rehabilitation treatment of patients.

Enhancing pain modulation: the efficacy of synchronous combination of virtual reality and transcutaneous electrical nerve stimulation

IntroductionVirtual reality (VR) and transcutaneous electrical nerve stimulation (TENS) have emerged as effective interventions for pain reduction. However, their standalone applications often yield limited analgesic effects, particularly in certain painful...

Clinical efficacy of electroacupuncture-like magnetic therapy compared to conventional transcutaneous electrical nerve stimulation in individuals with carpal tunnel syndrome

This study aimed to evaluate the clinical efficacy of an electroacupuncture-like magnetic therapy (ELMT) and conventional transcutaneous electrical nerve stimulation (TENS) in patients with carpal tunnel syndrome (CTS). A prospective randomized controlled trial in single-centre was conducted. Thirty-four CTS patients confirmed by electrodiagnostic study were randomized into TENS or ELMT group and completed a six-week treatment program. TENS or ELMT treatment was applied on acupuncture point PC-6 (Neiguan) and one selected hand acupoint. Therapeutic exercises were also included after the electrophysical modality. Their physical signs, motor and sensory performances, Boston Carpal Tunnel Questionnaire (BCTQ) scores, and results of electrodiagnostic study were evaluated. After treatments, both groups demonstrated significantly decreased BCTQ scores and positive rate of Tinel’s sign in the major symptomatic side, which indicated improvements in the symptom severity and physical functions. Significant increases in distal sensory amplitude and nerve conduction velocity of the median nerve were only found in the ELMT group. Our study found either conventional TENS or ELMT plus therapeutic exercises could improve the symptomatology and physical provocation sign of CTS. The ELMT has additional improvement in the nerve conduction in patients with CTS.

Comparing the effect of transcutaneous electrical nerve stimulation and massage therapy on post laparoscopic shoulder pain: a randomized clinical trial

BackgroundShoulder pain is a common clinical problem after laparoscopic surgeries. The use of non-pharmacological massage and transcutaneous electrical nerve stimulation (TENS) as an adjunct to routine treatment is increasing to provide optimal pain relief. Therefore, we aimed to determine the effect of TENS and massage therapy on post laparoscopic shoulder pain (PLSP).MethodsThis study was conducted on 138 patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into three groups: massage plus conventional pharmacological treatment (n = 46), TENS plus conventional pharmacological treatment (n = 46), and conventional pharmacological treatment (n = 46). Massage and TENS were performed three consecutive times after the patients regained consciousness in the inpatient wards. The intensity of Shoulder pain was evaluated using a visual analog scale before and 20 min after each treatment.ResultsBoth massage therapy and TENS led to a significant reduction in the intensity of PLPS compared to the control group in all three measured times (p < 0.001). However, no significant difference was observed between TENS and massage at any of the three-time points.ConclusionsThis study’s findings demonstrated that massage and TENS techniques could reduce PLSP.Trial registrationRegistered in the Iranian registry of clinical trials (www.irct.ir) in 05/02/2022 with the following code: IRCT20200206046395N1.

From pulse width modulated TENS to cortical modulation: based on EEG functional connectivity analysis.

Modulation in the temporal pattern of transcutaneous electrical nerve stimulation (TENS), such as Pulse width modulated (PWM), has been considered a new dimension in pain and neurorehabilitation therapy. Recently, the potentials of PWM TENS have been studied on sensory profiles and corticospinal activity. However, the underlying mechanism of PWM TENS on cortical network which might lead to pain alleviation is not yet investigated. Therefore, we recorded cortical activity using electroencephalography (EEG) from 12 healthy subjects and assessed the alternation of the functional connectivity at the cortex level up to an hour following the PWM TENS and compared that with the effect of conventional TENS. The connectivity between eight brain regions involved in sensory and pain processing was calculated based on phase lag index and spearman correlation. The alteration in segregation and integration of information in the network were investigated using graph theory. The proposed analysis discovered several statistically significant network changes between PWM TENS and conventional TENS, such as increased local strength and efficiency of the network in high gamma-band in primary and secondary somatosensory sources one hour following stimulation. Our findings regarding the long-lasting desired effects of PWM TENS support its potential as a therapeutic intervention in clinical research.

High intensity-transcutaneous electrical nerve stimulation does not inhibit temporal summation of the nociceptive flexion reflex

Pain facilitation contributes to chronic pain conditions. Transcutaneous electrical nerve stimulation (TENS) is used to alleviate pain. The effects of conventional TENS on chronic pain have been limited, and its effects on pain facilitation are controversial. Because the analgesic effects of TENS depend on the setting parameters (e.g., pulse intensities or treatment time), the optimal TENS settings to maximize analgesic effects under various pain conditions have been investigated. High-intensity TENS (HI-TENS), which involves tolerable-level pulse intensities for a short duration, is another conventional TENS method that used to alleviate pain. However, the effects of HI-TENS on pain facilitation remain unclear. The temporal summation of pain is widely used to evaluate pain facilitation, and the temporal summation-nociceptive flexion reflex (TS-NFR) is a neuropsychological parameter that can be used to evaluate pain facilitation. We aimed to investigate the effects of HI-TENS on the TS-NFR in healthy participants. Participants were randomly allocated into HI-TENS (n = 15) and control groups (n = 16). HI-TENS was administered at the left lateral lower leg for 1 min. The TS-NFR elicited by three noxious stimuluses at the left sural nerve was obtained from electromyography of the left biceps femoris. The nociceptive flexion reflex (NFR) was obtained by a single noxious stimulus. We measured the thresholds of the NFR and the TS-NFR at baseline and post-intervention. The application of HI-TENS significantly increased the NFR threshold (p = 0.013) but not the TS-NFR threshold (p > 0.05). These results suggest that HI-TENS does not inhibit pain facilitation.

Alteration in Cortical Activity and Perceived Sensation Following Modulated TENS.

Over the last decades, conventional transcutaneous electrical nerve stimulation (TENS) has been utilized as an efficient rehabilitation intervention for alleviation of chronic pain, including phantom limb pain (PLP). However, recently the literature has increasingly focused on alternative temporal stimulation patterns such as pulse width modulation (PWM). While the effect of non-modulated high frequency (NMHF) TENS on somatosensory (SI) cortex activity and sensory perception has been studied, the possible alteration following PWM TENS at the SI has not yet been explored. Therefore, we investigated the cortical modulation by PWM TENS for the first time and conducted a comparative analysis with the conventional TENS pattern. We recorded sensory evoked potentials (SEP) from 14 healthy subjects before, immediately, and 60 min after TENS interventions (PWM and NMHF). The results revealed suppression of SEP components, theta, and alpha band power simultaneously associated with the perceived intensity reduction when the single sensory pulses applied ipsilaterally to the TENS side. The reduction of N1 amplitude, theta, and alpha band activity occurred immediately after both patterns remained at least 60 min. However, the P2 wave was suppressed right after PWM TENS, while NMHF could not induce significant reduction immediately after the intervention phase. As such, since PLP relief has been shown to be correlated with inhibition at somatosensory cortex, we, therefore, believe that the result of this study provides further evidence that PWM TENS may also be potential therapeutic intervention for PLP reduction. Future studies on PLP patients with PWM TENS sessions is needed to validate our result.

A Review of Recent Clinical Studies of Transcutaneous Electrical Nerve Stimulation (TENS) on Xerostomia - PubMed and Domestic Studies

Objectives: The purpose of this study was to summarize current clinical study trends and results regarding transcutaneous electrical nerve stimulation (TENS) treatment for xerostomia.Methods: Studies published from 2017 to 2022 were searched on domestic databases and PubMed. The included studies were analyzed according to the year, language, study design, diagnosis xerostomia method, and TENS treatment method.Results: Nine studies were included. There were three randomized controlled trials (RCTs), three case series, one case report, one case-control study, and one cross-sectional study. Conventional TENS was used in seven studies, and acupuncture-like TENS (ALTENS) was used in one study. The most common TENS attachment site was externally on the skin overlying the parotid gland region, and the setting of TENS was 50 Hz-250 μs the most. In all nine studies, TENS was effective for xerostomia as assessed by salivary flow rate or quality of life questionnaire. Additionally, no persistent adverse events were reported after TENS treatment.Conclusions: TENS treatment for xerostomia can be considered effective and safe, so it can be used in clinical practice.

Role of Transcutaneous Electric Nerve Stimulation in Pain and Pulmonary Function in Patients after Bariatric Surgery.

Background Changes in lifestyle, a carbohydrate-rich diet, and decreased physical activity are part of the context that led to an obesity pandemic. Treating obesity is a task that requires multidisciplinary care; however, in many cases, conventional therapy has no effect, requiring surgical intervention. This, in turn, is not without risks and causes important changes in lung function. Therefore, the aim of this study is to evaluate the effect of electroanalgesia through conventional transcutaneous electrical nerve stimulation (TENS) on the pain and lung function in the postoperative period of bariatric surgery. Methods This is a controlled and blinded clinical trial with 66 subjects who underwent bariatric surgery. The participants were randomized into 2 groups as follows: an intervention group treated with TENS (n = 33) and a placebo group (n = 33). The participants underwent 4 TENS sessions, and the effect on pain was assessed using a visual analogue scale (VAS pain). Lung function was measured by spirometry. Results There were no differences between the 2 groups regarding time of surgery and time of mechanical ventilation. Compared to placebo, TENS reduced pain in the intervention group (p = 0.001). Regarding the effect of electroanalgesia on pulmonary function, the spirometric parameters were similar between the groups. However, regarding muscle strength between the preoperative and postoperative periods, maximal inspiratory pressure (MIP) was maintained in the intervention group and decreased in the placebo group (p = 0.03). Compared with that in the intervention group, the respiratory rate in the placebo group increased during the application of TENS (p = 0.003). Conclusion Electroanalgesia reduces pain in patients who underwent bariatric surgery. Importantly, in these patients, the MIP is maintained between the preoperative and postoperative periods. However, electroanalgesia does not contribute to improvements in spirometric data. This trial is registered with NCT04800640.

Effect of neuromorphic transcutaneous electrical nerve stimulation (nTENS) of cortical functional networks on tactile perceptions: an event-related electroencephalogram study

Background. Transcutaneous electrical nerve stimulation (TENS) is generally applied for tactile feedback in the field of prosthetics. The distinct mechanisms of evoked tactile perception between stimulus patterns in conventional TENS (cTENS) and neuromorphic TENS (nTENS) are relatively unknown. This is the first study to investigate the neurobiological effect of nTENS for cortical functional mechanism in evoked tactile perception. Methods. Twenty-one healthy participants were recruited in this study. Electroencephalogram (EEG) was recorded while the participants underwent a tactile discrimination task. One cTENS pattern (square pattern) and two nTENS patterns (electromyography and single motor unit patterns) were applied to evoke tactile perception in four fingers, including the right and left index and little fingers. EEG was preprocessed and somatosensory-evoked potentials (SEPs) were determined. Then, source-level functional networks based on graph theory were evaluated, including clustering coefficient, path length, global efficiency, and local efficiency in six frequency bands. Main results. Behavioral results suggested that the single motor units (SMUs) pattern of nTENS was the most natural tactile perception. SEPs results revealed that SMU pattern exhibited significant shorter latency in P1 and N1 components than the other patterns, while nTENS patterns have significantly longer latency in P3 component than cTENS pattern. Cortical functional networks showed that the SMU pattern had the lowest short path and highest efficiency in beta and gamma bands. Conclusion. This study highlighted that distinct TENS patterns could affect brain activities. The new characteristics in tactile manifestation of nTENS would provide insights for the application of tactile perception restoration.

Effect of Modulated TENS on Corticospinal Excitability in Healthy Subjects

Conventional transcutaneous electrical nerve stimulation (TENS) has been reported to effectively alleviate chronic pain, including phantom limb pain (PLP). Recently, literature has focused on modulated TENS patterns, such as pulse width modulation (PWM) and burst modulation (BM), as alternatives to conventional, non-modulated (NM) sensory neurostimulation to increase the efficiency of rehabilitation. However, there is still limited knowledge of how these modulated TENS patterns affect corticospinal (CS) and motor cortex activity. Therefore, our aim was to first investigate the effect of modulated TENS patterns on CS activity and corticomotor map in healthy subjects. Motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) were recorded from three muscles before and after the application of TENS interventions. Four different TENS patterns (PWM, BM, NM 40 Hz, and NM 100 Hz) were applied. The results revealed significant facilitation of CS excitability following the PWM intervention. We also found an increase in the volume of the motor cortical map following the application of the PWM and NM (40 Hz). Although PLP alleviation has been reported to be associated with an enhancement of corticospinal excitability, the efficiency of the PWM intervention to induce pain alleviation should be validated in a future clinical study in amputees with PLP.

Effect of TENS and stabilization exercises on pelvic pain in pelvic cancer survivors following multimodal treatment: A clinical trial.

Pelvic floor muscle (PFM) dysfunction and pain are common complications seen in pelvic cancers including the gynecological and genitourinary systems before and after treatments such as chemotherapy, radiotherapy, and surgeries and may contribute to significant morbidity as the survival rates increase in these patients. The objective of the clinical trial was to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) and stabilization exercises on pelvic pain in pelvic cancer survivors following multimodal treatment. Thirty-one patients including both male and female adults treated for pelvic cancers were recruited in the study. Outcome measures in terms of pain were assessed at baseline and at the end of the study by the visual analog scale and genitourinary pain index (GUPI) scale, abdominal muscle strength by pressure biofeedback unit for transverse abdominal (TrA) muscle, and quality of life (QOL) by functional assessment of cancer therapy general questionnaire. Pelvic stabilization exercises and TENS were administered once daily approximately 30 min during the acute hospitalization. Pelvic stabilization exercises and TENS demonstrated to be effective in ameliorating pelvic pain (P < 0.001) and improving in the GUPI scores of pain, incontinence, increasing strength of TrA musculature (P < 0.001), and improving overall QOL (P < 0.005). The trial suggests that a combination of pelvic stabilization exercises and conventional TENS may be used as a strategic tool to reduce pain and improve PFM strength after multimodal treatments in pelvic cancer survivors in the clinical setup of an Indian Scenario.

A COMPARATIVE CLINICAL STUDY ON PATRA PINDA SWEDA AND TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION ON GRIDHRASI WITH SPECIAL REFERENCE TO SCIATICA

Gridhrasi is a Vata Nanatmaja Vyadhi characterized by Ruk (pain), Toda (pricking pain), Stambha (stiffness) and Spandana (frequents twitching). These symptoms initially affect Sphik (buttock) as well as the posterior aspect of Kati (waist) and then gradually radiates to posterior aspects of Uru (thigh), Janu (knee), Jangha (calf) and Pada (foot). It is dominated by pain that affects the Kandara due to morbid Vata Dosha and Kapha Dosha can also be involved in the clinical presentation. Snehana and Swedana are considered as the general line of treatment for Vatavikaras which can be taken as a line of treatment for Gridhrasi. Patra Pinda Sweda being one among Sankara Sweda is Sagni and Snigdha Ruksha type of Sweda. In this medicinal leaves having Vata-Kaphahara, Shothahara and Vedanasthapaka properties are fried in Sahachara Taila and tied into Pottali. Thus, by virtue of its Guna pos- sess the best Snehana and Swedana effect and acts in respective Avasta of the disease Gridhrasi. There are a number of treatments plans available for sciatica. However transcutaneous electrical nerve stimulation (TENS) is a simple, non-invasive analgesic technique that is used extensively in health care settings by physiotherapists for sciatica. The use of conventional transcutaneous electrical nerve stimulation is originally based on the gate control theory of pain and TENS could also raise endorphin levels in the spinal fluid. Methodology: A comparative clinical study was done on forty subjects of both sexes, between the age group of 20-60 years who were randomly assigned into two groups, namely group A where Patra Pinda Sweda was administered to the subjects and group B wheretranscutaneous electrical nerve stimulation was applied to the subjects. After completion of the study, results were assessed using the student 't’ test by comparing the data collected during the study. Result: Comparatively group A proved to be more effective than group B. Group A overall result is 66.73% and Group B overall result is 47.07%. Keywords: Gridhrasi, Physiotherapy, Sahacahara Taila, Snehana, Swedana

Effect of Transcutaneous Electrical Nerve Stimulation and Cupping Therapy in The Treatment of Tennis Elbow: A Randomized Controlled Trial

Background: Tennis elbow (TE) is a common disorder of the upper extremities that occurs due to powerful grip and repetitive motions in the wrist joint during various activities. Although several management strategies have discussed some of the methods used to reduce pain and improve elbow and wrist movements, the use of new approaches remains a vigorous option to reach the maximum degree of improvement and complete recovery.Aim: The current study aimed to investigate the effect of Transcutaneous electrical nerve stimulation (TENS) and cupping therapy in treating TE.Methods: One hundred and twenty patients between the ages of 20 and 50 years of both sexes complained of tennis elbow. They were divided randomly into four groups. Group A (n=30) received conventional treatment, group B (n=30) received TENS in addition to conventional treatment, group C (n=30) received cupping therapy with conventional treatment, and group D (n=30) received TENS and cupping therapy plus conventional treatment. Visual analog scale (VAS) was used to assess pain intensity, a hand dynamometer was used to measure pain-free grip strength (PFGS), and a patient-rated tennis elbow evaluation (PRTEE) questionnaire was used to measure pain and disability of the forearm before and after four weeks.Results: There was a significant decrease in VAS, PRTEE score, and an increase in PFGS favoring group D compared to the other groups post-treatment (p &lt; 0.001).Conclusion: The combination of TENS and cupping therapy results in better improvement in TE treatment than conventional therapy, TENS, and cupping therapy alone.

Acupuncture-like versus conventional transcutaneous electrical nerve stimulation in the management of active myofascial trigger points: A randomized controlled trial

PurposeMyofascial pain syndrome (MPS) is one of the most common causes of chronic musculoskeletal pain. The transcutaneous electrical nerve stimulation (TENS) is a non-expensive, safe, feasible modality, used recently for the treatment of MPS with promising but limited results. The purpose of this study was to determine the efficacy of acupuncture-like TENS (AL-TENS) vs conventional TENS (C-TENS) in the treatment of active myofascial trigger points. MethodsThis randomized controlled trial study was carried out with 60 consecutive patients with active trapezius trigger points referred to Physical Medicine and Rehabilitation Clinic. Participants randomly assigned to receive AL-TENS, C-TENS or sham TENS (S-TENS). The Visual Analogue Scale (VAS), Pressure Pain Thresholds (PPTs), and neck range of motion (ROM) were measured at baseline, after the first treatment sessions, after the final treatment session, and 3 months after the end of the last treatment session. Patients function was evaluated by Disabilities of the Arm, Shoulder, and Hand (DASH) at baseline, after the final treatment sessions, and 3 months after the end of intervention. ResultsThe interaction effect of time and group was significantly different when evaluating VAS (df = 4.65, F = 2.50, p = 0.038) and DASH (df = 2.63, F = 7.25, p < 0.001) in favor of active groups, as well as neck total lateral bending in favor of AL-TENS group compared other two groups (df = 4.16, F = 5.23, p = 0.001). Both VAS and DASH improved significantly at all follow-ups in AL-TENS and C-TENS groups. Of note, significant immediate improvement in all outcomes was observed only with AL-TENS. ConclusionsAccording to the present study, both AL-TENS and C-TENS were superior to placebo in pain reduction and functional improvement. Although both TENS techniques have similar efficiency on pain reduction, functional and pain perception improvement, the AL-TENS was the superior approach when evaluating neck lateral bending ROM.

Does transcutaneous electrical nerve stimulation affect pain, neuropathic pain, and sympathetic skin responses in the treatment of chronic low back pain? A randomized, placebo-controlled study.

BackgroundThe purpose of this study was to assess the effectiveness of transcutaneous electrical nerve stimulation (TENS) in chronic low back pain and neuropathic pain.MethodsSeventy-four patients aged 18-65 with chronic low back pain were included in the study. Baseline measurements were performed, and patients were randomized into three groups. The first group received burst TENS (bTENS), the second group conventional TENS (cTENS), and the third group placebo TENS (pTENS), all over 15 sessions. Patients’ visual analogue scale (VAS) scores were evaluated before treatment (preT), immediately after treatment (postT), and in the third month after treatment (postT3). Douleur Neuropathique 4 Questions (DN4), the Modified Oswestry Low Back Pain Disability Questionnaire (MOS), the Beck Depression Inventory (BDI), and sympathetic skin response (SSR) values were also evaluated preT and postT3.ResultsA statistically significant improvement was observed in mean VAS scores postT compared to preT in all three groups. Intergroup comparison revealed a significant difference between preT and postT values, that difference being assessed in favor of bTENS at multiple comparison analysis. Although significant improvement was determined in neuropathic pain DN4 scores measured at postT3 compared to preT in all groups, there was no significant difference between the groups. No statistically significant difference was also observed between the groups in terms of MOS, BDI, or SSR values at postT3 (P > 0.05).ConclusionsbTENS therapy in patients with low back pain is an effective and safe method that can be employed in short-term pain control.

Effects of Lumbar Mobilization on the Paravertebral Muscle Activity and Muscle Tone in Patients with Lumbar Spinal Stenosis

Background: Patients with lumbar spinal stenosis show abnormal changes in muscle activity due to pain and limited range of motion of the lumbar spine. Excessive increased muscle tone and decreased muscle activity patterns threaten the patients’ quality of life. However, there have been a few studies showing how to improve muscle performance in patients with lumbar spinal stenosis. Among these, joint mobilization is one way of improving muscle performance through pain relief and increasing the range of motion. Objectives: To investigate the effect of lumbar mobilization by orthopedic manual physical therapy on paravertebral muscle activity and tone in patients with lumbar spinal stenosis. Design: A randomized controlled trial. Methods: In this study, 24 patients with lumbar spinal stenosis were randomized (1:1 ratio) into two groups. The experimental group underwent lumbar posteroanterior mobilization, and the control group underwent conventional physical therapy (conventional transcutaneous electrical nerve stimulation) for 15 minutes each. For outcome measures, MyotonⓇPRO was used to evaluate muscle tone when resting of the paravertebral muscle in the pain area. For muscle activity evaluation, the reference voluntary contraction of the paravertebral muscle was evaluated using surface electromyography. Results: Muscle tone and activity were significantly improved after intervention in both the experimental and control groups. In addition, the experimental group showed more significant decrease in muscle tone and activity than the control group. Conclusion: These results suggest that lumbar mobilization improving muscle performance in patients with lumbar spinal stenosis.

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

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). PerspectiveThis 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.

Supraspinal neural mechanisms of the analgesic effect produced by transcutaneous electrical nerve stimulation.

Although the analgesic effects of conventional transcutaneous electrical nerve stimulation (TENS) and acupuncture-like TENS are evident, their respective neural mechanisms in humans remain controversial. To elucidate and compare the supraspinal neural mechanisms of the analgesic effects produced by conventional TENS (high frequency and low intensity) and acupuncture-like TENS (low frequency and high intensity), we employed a between-subject sham-controlled experimental design with conventional, acupuncture-like, and sham TENS in 60 healthy human volunteers. In addition to assessing the TENS-induced changes of subjective ratings of perceived pain, we examined the TENS associated brainstem activities (fractional amplitude of low frequency fluctuations, fALFF) and their corresponding resting state functional connectivity (RSFC) with higher-order brain areas using functional magnetic resonance imaging. The analgesic effect of conventional TENS was only detected in the forearm that received TENS, coupled with decreased pons activity and RSFC between pons and contralateral primary somatosensory cortex. In contrast, acupuncture-like TENS produced a spatially diffuse analgesic effect, coupled with increased activities in both subnucleus reticularis dorsalis (SRD) and rostral ventromedial medulla (RVM), and decreased RSFC between SRD and medial frontal regions as well as between SRD and lingual gyrus. To sum up, our data demonstrated that conventional TENS and acupuncture-like TENS have different analgesic effects, which are mediated by different supraspinal neural mechanisms.

Effectiveness of Transcutaneous Electrical Nerve Stimulation on Pain and Disability Among Patients with Hip Arthroplasty: A Randomized Control Study

Background: Pain after surgery is highly inevitable, and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been reported with side effects. Objectives: This study evaluated the effectiveness of transcutaneous electrical nerve stimulation (TENS) on pain intensity and disability of patients who underwent hip arthroplasty. Methods: A purposive sampling technique was used to recruit 56 subjects that underwent hip arthroplasty. They were randomly allocated to the TENS group (TG) and control group (CG) equally. The subjects in the TG group were treated with conventional TENS twice a day for three weeks, but the CG group was treated with normal drugs only. Pain intensity and hip disability were measured in both groups with the Visual Analogue scale (VAS) and Oxford hip score before the treatment and after the intervention, respectively. Results: The results showed that there was a significant reduction between the pre-treatment and post-treatment pain intensity (t = 3.83, P = 0.003) and hip disability (t = -4.45, P &lt; 0.001) in the TG group. A significant reduction was also observed in pain intensity (t = 3.16, P = 0.01) and hip disability (t = -6.71, P = 0.000) between the pre-treatment and post-treatment periods in the CG group. There was a significant reduction in post-treatment pain intensity (t = 10, P = 0.000) and hip disability (t = -3.51, P = 0.006) when the TG group was compared with the CG group. Conclusions: TENS was effective in the management of acute post-surgical pain and disability of patients with hip arthroplasty.