Electrical Nerve Stimulation Research Articles

An Overview of Electrical Nerve Stimulation via Transdermal Application

The risk of dying from cardiovascular and cerebrovascular diseases is significantly increased by hypertension. The primary issues affecting public health at the moment are hypertension and its consequences. Some persons with hypertension, even under intensive therapeutic supervision, do not achieve the specified blood pressure (BP) treatment targets. Patients with resistant hypertension (RH) may be defined as those who need to take three or more different kinds of antihypertensive medications in order to reach their blood pressure target. Utilizing the body's natural bioelectric system, bioelectric technology is a relatively new approach. In auxiliary evaluation, pain management, and organ function rehabilitation, it is commonly used. Renal sympathetic denervation, carotid baroreflex activation therapy, electroacupuncture in traditional Chinese medicine, and transcutaneous electrical nerve stimulation are the primary forms of bioelectrical technology, which has advanced quickly in recent years as an effective treatment for RH.

The Effects of Transcutaneous Electrical Nerve Stimulation and Ultrasound Treatment Combined with High Intensity Laser Treatment on Pain, Grip Strength, and Hand Function in Patients with Carpal Tunnel Syndrome

The Effects of Transcutaneous Electrical Nerve Stimulation and Ultrasound Treatment Combined with High Intensity Laser Treatment on Pain, Grip Strength, and Hand Function in Patients with Carpal Tunnel Syndrome

Comparative analysis of two different physiotherapy intervention programs in individuals experiencing chronic lower back pain

Background and objectives. Physiotherapy programs in individuals experiencing chronic lower back pain (CLBP) aim to improve function, disabilities from worsening. As per clinical practice guidelines, many methods are applied, such as the McKenzie method, therapeutic exercises, transcutaneous electrical nerve stimulation (TENS), traction, thermotherapy etc. The effectiveness of these methods is supported by a wide range of evidence and studies, making them some of the most diverse and well-established approaches. These physiotherapeutic treatments are combined every day. Therefore, the aim of this research is to provide a comparative investigation on two different physiotherapy programs containing a combination of these treatment modalities in individuals with CLBP. Materials and methods. This research involved 60 patients who were separated into two groups. Group I received the McKenzie treatment method, passive modalities, lumbar traction, and a walking program. Group II received therapeutic exercises, passive modalities, lumbar traction, and a walking program. Both groups underwent treatment for six weeks. Subjects were tested using research instruments at the beginning, at the end of three weeks, and at the end of six weeks of treatment. The evaluation instruments used were the visual analog scale, Finger-to-Floor test, the Oswestry Low Back Pain Disability Questionnaire, and the Rosenberg self-esteem scale. Results. Pain intensity, functional disability, lumbar flexibility, and self-confidence showed greater improvement after six weeks of treatment in both programs (p <0.0001), without any significant statistical difference among the groups (p >0.05). Conclusions. The data obtained from both groups support the effectiveness of both treatment programs and suggest that they can be considered as options for viable programs treatment for patients with CLBP.

High-frequency, high-intensity TENS compared to standard treatment with opioids for postoperative pain relief after laparoscopic cholecystectomy: A multicentre randomized controlled trial.

Adverse effects of opioids could prolong the duration of stay in the post-anaesthesia care unit (PACU). This study aimed to assess time in the PACU and the pain-relieving effect of high-frequency, high-intensity transcutaneous electrical nerve stimulation (HFHI TENS) versus standard treatment with intravenous (IV) opioids. Patients undergoing laparoscopic cholecystectomy at two Swedish hospitals were invited to participate. Patients reporting postoperative pain intensity ≥3 according to the Numeric Rating Scale (NRS) in the PACU were randomized to receive standard treatment with IV opioids or HFHI TENS, administered with an intensity of 40-60 mA for 1 min, repeated once if insufficient pain relief. If NRS remained ≥3 after two TENS stimulation the patients received IV opioids. In total, 163 patients were randomized to receive HFHI TENS (n = 85) or IV opioids (n = 78). There was no difference between the HFHI TENS group versus the opioid group regarding time in the PACU (138 min [SD 69] vs. 142 min [SD 95], mean difference -4.42 [95% CI-30:22], p = 0.74), time to pain relief NRS < 3 (median 10 min) and pain intensity at PACU discharge (NRS 1.7 [SD 1.45] vs. 1.6 [SD 1.20], p = 0.58). In the HFHI TENS group, 39 patients (46%) needed additional treatment with IV opioids. Mean opioid consumption was significantly lower in the HFHI TENS group than in the opioid group (4.5 vs. 11.0 morphine equivalents; p < 0.001). HFHI TENS may be an opioid-sparing alternative for postoperative pain relief. In this multicentre, RCT time in the PACU and the pain-relieving effect of HFHI TENS was compared to standard treatment with IV opioids. There were no differences between the groups regarding time in the PACU, time to pain relief and side effects but opioid consumption in the HFHI TENS group was significantly lower. Both groups reported high satisfaction with pain treatment and care. In summary, HFHI TENS should be considered a safe, fast-onsetting, opioid-sparing option for postoperative pain relief.

Влияние консервативной терапии на зрительные функции и гемодинамику глаз при первичной открытоугольной глаукоме

Aim. To evaluate the effect of combined conservative therapy on the condition of visual functions and ocular hemodynamics in primary open-angle glaucoma. Methods. The study included 14 patients (22 eyes) aged from 59 to 83 years. All the patients underwent visometry, static Humphrey perimetry, tonometry, biomicroscopy, gonioscopy, ophthalmoscopy and optical coherence tomography (including the Angio-disk protocol) using Optovue RTVue-100 device. All the studies were performed before and after a course of conservative treatment. Patients received a course of conservative treatment for 10 days including Emoxipine 10 mg/ml – 0.5 s/с № 5, Mildronate 100 mg/ml – 0.5 s/с № 5, Piracetam 200 mg/ml – 2.0 i/m № 10, Nicotinic acid 10 mg/ml – 2.0 i/m № 10. Electrical stimulation of the optic nerve № 10, low-frequency magnetic therapy № 10, laser stimulation of the retina № 10 were also performed. Results The course of conservative therapy led to an increase in visual acuity, average light sensitivity of the retina, a decrease in the level of intraocular pressure, an increase in the thickness of the choroid, and an increase in the density of capillaries of the optic nerve head. Conclusions. Regular courses of conservative therapy in patients with primary openangle glaucoma may preserve visual functions. Key words: conservative therapy; primary open-angle glaucoma; visual functions; ocular hemodynamics.

Elucidating the molecular mechanisms behind the therapeutic impact of median nerve stimulation on cognitive dysfunction post-traumatic brain injury

ObjectiveFerroptosis represents a form of regulated cellular death dependent upon iron and lipid peroxidation derivatives, holding considerable implications for cerebral and neurologic pathologies. In the present study, we endeavored to elucidate the molecular mechanisms governing ferroptosis and appraise the therapeutic value of electrical stimulation of median nerve in addressing cognitive impairments following traumatic brain injury (TBI), employing a rodent model. MethodsIn this study, we established a rat model to investigate the cognitive impairments resulting from TBI, followed by the application of median nerve stimulation (MNS). Initially, rats received an intraperitoneal injection of Erastin (2 mg/kg) prior to undergoing MNS. After 24 h of MNS treatment, the rats were subjected to an open field test to evaluate their cognitive and motor functions. Subsequently, we conducted biochemical assays to measure the serum levels of GSH, MDA and SOD. The structural integrity and cellular morphology of hippocampal tissue were examined through H&E staining, Nissl staining and transmission electron microscopy. Additionally, we assessed the expression levels of proteins crucial for neuronal health and function in the hippocampus, including VEGF, SLC7A11, GPX4, Nrf2, α-syn, NEUN and PSD95. ResultsCompared to the control group, rats in the stimulation group demonstrated enhanced mobility, reduced levels of tissue damage, a decrease in MDA concentration, and increased levels of GSH and SOD. Additionally, there was a significant upregulation in the expression of proteins critical for cellular defense and neuronal health, including GPX4, SLC7A11, Nrf2, VEGF, α-syn, NEUN, and PSD95 proteins. Conversely, rats in the Erastin group demonstrated decreased mobility, exacerbated pathological tissue damage, elevated MDA concentration, and decreased levels of GSH and SOD. There was also a notable decrease in the expression of GPX4, SLC7CA11, Nrf2, and VEGF proteins. The expression levels of α-syn, NEUN, and PSD95 were similarly diminished in the Erastin group. Each of these findings was statistically significant, indicating that MNS exerts neuroprotective effect in the hippocampal tissue of rats with TBI by inhibiting the ferroptosis pathway. Conclusion(1) MNS may enhance the cognitive and behavioral performance of rats after TBI; (2) MNS can play a neuroprotective role by promoting the expression of nerve injury-related proteins, alleviating oxidative stress and ferroptosis process; (3) MNS may inhibit ferroptosis of neuronal cells by activating Nrf2/ GPX4 signaling pathway, thereby improving cognitive impairment in TBI rats.

The positive effect of pulse electromagnetic field therapy on pain and disability in chronic low back pain: a comparative study

BackgroundLow back pain that lasts longer than three months is called chronic low back pain. Chronic low back pain is among the most common problems in the world, causing severe disability and loss of employment in patients.ObjectiveTo investigate the effect of pulse electromagnetic field therapy (PEMFT) added to routine physical therapy on pain and functional status in patients with chronic low back pain.MethodsThis retrospective comparative study included 69 patients with chronic low back pain. The patients were divided into two groups: those who received lumbar transcutaneous electrical nerve stimulation, infrared, and ultrasound treatments, and those who additionally received PEMFT. The files of patients with chronic low back pain were reviewed, and those who had been evaluated using the Quebec Back Pain Disability Scale (QBPDS) in terms of functional capacity and effects of low back pain and the Visual Analogue Scale (VAS) for pain both before and after treatment were included in the study.ResultsNo significant difference was detected between the two groups’ pretreatment VAS and QBPDS scores (p > 0.05). The second-and-third measurement scores of both groups were significantly lower than their first-measurement VAS and QBPDS scores (p ˂ 0.001), but there was no significant difference between their second- and third-measurement scores (p > 0.05). According to the inter-group comparison of the VAS and QBPDS scores, the second and third-measurement scores of the PEMFT group were significantly lower than those of the control group (p ˂ 0.001).ConclusionsPEMFT seems to be able to alleviate pain intensity and ameliorate disability in patients with chronic low back pain. PEMFT can be considered an effective and safe option that can be added to routine physical therapy modalities for relieving chronic low back pain frequently encountered in clinical practice. Further studies validating the effectiveness of PEMFT could strengthen its position in the management of chronic low back pain.

Creation of a biological sensorimotor interface for bionic reconstruction

Neuromuscular control of bionic arms has constantly improved over the past years, however, restoration of sensation remains elusive. Previous approaches to reestablish sensory feedback include tactile, electrical, and peripheral nerve stimulation, however, they cannot recreate natural, intuitive sensations. Here, we establish an experimental biological sensorimotor interface and demonstrate its potential use in neuroprosthetics. We transfer a mixed nerve to a skeletal muscle combined with glabrous dermal skin transplantation, thus forming a bi-directional communication unit in a rat model. Morphological analyses indicate reinnervation of the skin, mechanoreceptors, NMJs, and muscle spindles. Furthermore, sequential retrograde labeling reveals specific sensory reinnervation at the level of the dorsal root ganglia. Electrophysiological recordings show reproducible afferent signals upon tactile stimulation and tendon manipulation. The results demonstrate the possibility of surgically creating an interface for both decoding efferent motor control, as well as encoding afferent tactile and proprioceptive feedback, and may indicate the way forward regarding clinical translation of biological communication pathways for neuroprosthetic applications.

The effect of EMS, IFC, and TENS on patient-reported outcome measures for chronic low back pain: a systematic review and meta-analysis.

Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Transcutaneous electrotherapies have been widely used to treat CLBP but, with the partial exception of transcutaneous electrical nerve stimulation (TENS), their effect on pain, disability, quality-of-life, and psychosocial outcomes have not been systematically reviewed. The purpose of this systematic review and meta-analysis was to clarify the overall effect of transcutaneous electrotherapies on patient-reported outcome measures (PROMs) in CLBP patients. Four databases and two study registries were searched for studies that utilized transcutaneous electrotherapies as a primary intervention for CLBP, compared against active or passive controls. Two reviewers independently extracted study data and assessed risk of bias. Studies were grouped by intervention vs. comparison, and by time of follow-up. Meta-analyses were conducted where appropriate. A total of 89 full-text were assessed for eligibility; 14 studies were included, with 6 in the meta-analyses (all TENS or mixed TENS). Pain: meta-analyses revealed no significant difference for TENS vs. active control, TENS vs. passive control, or mixed TENS vs. active control at post-intervention, nor for mixed TENS vs. active control at 1-month post-intervention. Interferential current (IFC) was more effective than active control (2 studies), while electromyostimulation (EMS) was generally superior to passive, but not active, controls (6 studies). Meta-analyses revealed no significant difference for TENS vs. active control at post-intervention, mixed TENS vs. active control at post-intervention, or mixed TENS vs. active control at 1-month post-intervention. IFC was more effective than active control (2 studies), while the EMS results were mixed (6 studies). We were unable to perform meta-analyses for quality-of-life or psychosocial outcomes. There is moderate evidence that TENS is similar to all controls for improving pain and disability. There is limited evidence that IFC is superior to active controls for improving pain and disability. There is limited evidence that EMS is superior to passive but not active controls for improving pain, and similar to all controls for improving disability. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=452851, Identifier (CRD42023452851).

Brachial Plexus Injury Influences Efferent Transmission on More than Just the Symptomatic Side, as Verified with Clinical Neurophysiology Methods Using Magnetic and Electrical Stimulation.

The variety of sources of brachial plexus injuries (BPIs) and the severity and similarity of their clinical symptoms with those of other injuries make their differential diagnosis difficult. Enriching their diagnosis with objective high-sensitivity diagnostics such as clinical neurophysiology may lead to satisfactory treatment results, and magnetic stimulation (MEP) might be an advantageous addition to the diagnostic standard of electrical stimulation used in electroneurography (ENG). The asymptomatic side in BPI cases sometimes shows only subclinical neurological deficits; this study aimed to clarify the validity and utility of using MEP vs. ENG to detect neural conduction abnormalities. Twenty patients with a BPI and twenty healthy volunteers with matching demographic and anthropometric characteristics were stimulated at their Erb's point in order to record the potentials evoked using magnetic and electrical stimuli to evaluate their peripheral motor neural transmission in their axillar, musculocutaneous, radial, and ulnar nerves. MEP was also used to verify the neural transmission in participants' cervical roots following transvertebral stimulations, checking the compatibility and repeatability of the evoked potential recordings. The clinical assessment resulted in an average muscle strength of 3-1 (with a mean of 2.2), analgesia that mainly manifested in the C5-C7 spinal dermatomes, and a pain evaluation of 6-4 (mean of 5.4) on the symptomatic side using the Visual Analog Scale, with no pathological symptoms on the contralateral side. A comparison of the recorded potentials evoked with magnetic versus electrical stimuli revealed that the MEP amplitudes were usually higher, at p = 0.04-0.03, in most of the healthy volunteers' recorded muscles than in those of the group of BPI patients, whose recordings showed that their CMAP and MEP amplitude values were lower on their more symptomatic than asymptomatic sides, at p = 0.04-0.009. In recordings following musculocutaneous and radial nerve electrical stimulation and ulnar nerve magnetic stimulation at Erb's point, the values of the latencies were also longer on the patient's asymptomatic side compared to those in the control group. The above outcomes prove the mixed axonal and demyelination natures of brachial plexus injuries. They indicate that different types of traumatic BPIs also involve the clinically asymptomatic side. Cases with predominantly median nerve lesions were detected in sensory nerve conduction studies (SNCSs). In 16 patients, electromyography revealed neurogenic damage to the deltoid and biceps muscles, with an active denervation process at work. The predominance of C5 and C6 brachial plexus injuries in the cervical root and upper/middle trunk of patients with BPI has been confirmed. A probable explanation for the bilateral symptoms of dysfunction detected via clinical neurophysiology methods in the examined BPI patients, who showed primarily unilateral damage, maybe the reaction of their internal neural spinal center's organization. Even when subclinical, this may explain the poor BPI treatment outcomes that sometimes occur following long-term physical therapy or surgical treatment.

Interventional Management Of Neuropathic Ocular Pain – A Scoping Review

Neuropathic Ocular Pain (NOP) is a debilitating and refractory pain condition. This scoping review is the first to summarize the current evidence of efficacy of interventional treatment options for NOP. Databases were searched for studies published up to March 31, 2023. Two reviewers screened and extracted data, and performed the risk of bias analysis. Twelve studies were included, consisting of 4 cohort studies and 8 case series/reports, with a total of 87 patients. Eight interventions were defined: stellate ganglion block (n=1), trigeminal nerve blocks (n=3), retrobulbar block (n=1), pulsed radiofrequency of sphenopalatine ganglion (n=1), Onabotulinum-Toxin A(n=1), trigeminal nerve stimulation (n=1), intrathecal drug delivery (n=1) and transcutaneous electrical trigeminal nerve stimulation (n=3). Procedures were found to be safe and demonstrated analgesic effect. Follow-up ranged from 24h to 12 months. Substantial heterogeneity across studies was found, and quality was deemed low and of moderate risk of bias. High-quality studies are urgently needed.

Effectiveness of transcutaneous electrical nerve stimulation (TENS) modality for treating myofascial pain syndrome: A systematic review and meta-analysis

Effectiveness of transcutaneous electrical nerve stimulation (TENS) modality for treating myofascial pain syndrome: A systematic review and meta-analysis

A systematic review and bayesian meta-analysis of medical devices used in chronic pain management

Whilst. pharmacological therapies remain the cornerstone of pain management in chronic pain, factors including the current opioid epidemic have led to non-pharmacological techniques becoming a more attractive proposition. We explored the prevalence of medical device use and their treatment efficacy in non-cancer pain management. A systematic methodology was developed, peer reviewed and published in PROSPERO (CRD42021235384). Key words of medical device, pain management devices, chronic pain, lower back pain, back pain, leg pain and chronic pelvic pain using Science direct, PubMed, Web of Science, PROSPERO, MEDLINE, EMBASE, PorQuest and ClinicalTrials.gov. All clinical trials, epidemiology and mixed methods studies that reported the use of medical devices for non-cancer chronic pain management published between the 1st of January 1990 and the 30th of April 2022 were included. 13 studies were included in systematic review, of these 6 were used in the meta-analysis. Our meta-analysis for pain reduction showed that transcutaneous electrical nerve stimulation combined with instrument-assisted soft tissue mobilization treatment and pulsed electromagnetic therapy produced significant treatment on chronic lower back pain patients. Pooled evidence revealed the use of medical device related interventions resulted in 0.7 degree of pain reduction under a 0–10 scale. Significant improvement in disability scores, with a 7.44 degree reduction in disability level compared to a placebo using a 50 score range was also seen. Our analysis has shown that the optimal use of medical devices in a sustainable manner requires further research, needing larger cohort studies, greater gender parity, in a more diverse range of geographical locations.

Is Transcutaneous Electrical Nerve Stimulation Therapy the Answer for Tinnitus: A Prospective Study.

The study was aimed at determining the effectiveness of transcutaneous electrical nerve stimulation in treatment of tinnitus using Tinnitus handicap inventory (THI) and Visual analogue scale (VAS). 60 patients with bilateral, non-pulsatile, chronic subjective tinnitus; aged 18-65 years were subjected to 8 sessions (2 sessions/week) of TENS therapy given over a total period of 4 weeks. Pre-treatment and Post-treatment VAS, THI scores were compiled and analyzed statistically. A significant decrease in Tinnitus severity was seen after TENS Therapy (VAS: Loudness, Annoyance, Duration, Hampering of daily activities) (P value < 0.001). Moreover THI (Functional, Emotional & catastrophic) showed significant improvement (P value < 0.001). TENS is safe, effective, noninvasive therapeutic option for treatment of tinnitus.

A Comparative Study on the Transcutaneous Electrical Nerve Stimulation versus Intermittent Lumbar Traction in Chronic Non-Specific Low Back Pain Combined with the Extensor Endurance Exercise Regime

A Comparative Study on the Transcutaneous Electrical Nerve Stimulation versus Intermittent Lumbar Traction in Chronic Non-Specific Low Back Pain Combined with the Extensor Endurance Exercise Regime

Efficacy of Parasacral Transcutaneous Electrical Nerve Stimulation in Children with Refractory Detrusor Overactivity

Efficacy of Parasacral Transcutaneous Electrical Nerve Stimulation in Children with Refractory Detrusor Overactivity

Efficacy of transcutaneous electrical nerve stimulation combined with mirabegron therapy compared with mirabegron monotherapy for overactive bladder: a prospective randomized controlled study.

The objective was to evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) combined with mirabegron therapy compared with mirabegron monotherapy in the treatment of female patients with overactive bladder (OAB). In this randomized controlled study, 100 female outpatients with OAB were screened. Among these patients, 86 who met the inclusion criteria were randomly divided into the TENS combined with mirabegron treatment group and mirabegron monotherapy treatment group, with 43 patients in each group. The voiding diary, Overactive Bladder Symptom Score (OABSS), Overactive Bladder Questionnaire Symptom Bother Score (OAB-q SBS), total health-related quality of life (OAB-q HRQoL), and treatment satisfaction-visual analog scale (TS-VAS) score before and after treatment were recorded to evaluate the efficacy of OAB treatment. Seventy-nine of the 86 patients (40 in the TENS plus mirabegron group and 39 in the mirabegron monotherapy group) completed 12 weeks of treatment. TENS combined with mirabegron therapy was superior to mirabegron monotherapy in improving the primary endpoints, including the daily number of micturition episodes and the daily MVV/micturition and secondary endpoints, including the daily number of urgency episodes, the OABSS, the OAB-q SBS, the HRQoL score and TS-VAS score. There were no statistically significant differences in urgency urinary incontinence and nocturia between the groups. Some minor adverse effects were observed, including muscle pain, local paresthesia and constipation. The combination of TENS and mirabegron was more effective than mirabegron alone in the treatment of female patients with OAB. ChiCTR2400080528 (31.01.2024, retrospectively registered).

Early Physical Therapy Management of a Patient with Diaphragmatic Eventration Following Diaphragmatic Plication: A Case Report

AbstractDiaphragmatic plication is the recommended surgical procedure for the treatment of diaphragmatic eventration in those who have failed conservative care. The present case report describes a 63-year-old male patient who presented with breathlessness on exertional activities. Chest X-ray and Computed Tomography (CT) of the thorax revealed diaphragmatic eventration on the right side. After failed conservative management, the patient underwent diaphragmatic plication surgery and was followed up with postoperative physical therapy management. Physical therapy intervention was started from 3 days postsurgery and was continued for 1 week. The treatment goals focused on reducing breathlessness, reducing pain on the incision site, preventing postoperative complications, and improving functional capacity. The present study highlights the benefits of early physical therapy interventions including incentive spirometer, dyspnea relieving techniques, Transcutaneous Electrical Nerve Stimulation (TENS), and light- to moderate-intensity aerobic exercises in the patient after plication surgery.

Combined Effects of Manual Therapy and Functional Electrical Stimulation on Torticollis among Adults

Background: Acquired muscular torticollis is a common musculoskeletal disorder that occurs after birth due to various etiologies. This condition is characterized by the abnormal tilt and twist of the neck muscles, causing significant discomfort and functional impairment. Objective: This study aimed to investigate the combined effects of manual therapy and functional electrical stimulation (FES) on adults with acquired torticollis. Methods: A 45-year-old male patient with acquired torticollis was evaluated using a detailed general movement assessment and an arthrodial goniometer to measure cervical ranges of motion. The patient exhibited tightness of the right sternocleidomastoid (SCM) muscle with limited ranges of motion. The treatment protocol included both manual therapy and electrotherapy for three months, with sessions conducted four days per week, each lasting 40 minutes. Manual therapy consisted of soft tissue mobilization, stretching of the right SCM, and isometric exercises for the left SCM. Electrotherapy included transcutaneous electrical nerve stimulation (TENS), DL2 stimulator, infrared radiation therapy (IRR), and ultrasonic therapy. The patient’s cervical ranges of motion were measured before and after the intervention to assess the effectiveness of the combined therapy. Results: Significant improvements were observed in the patient’s cervical ranges of motion after the 12-week treatment protocol. The mean lateral flexion of the affected right SCM improved from 35 degrees to 20 degrees, and the mean rotation improved from 43 degrees to 28 degrees. These changes indicate a noticeable improvement in both the ranges of motion and posture of the patient. Conclusion: The combined effects of manual therapy and functional electrical stimulation significantly improved the cervical ranges of motion and overall posture in an adult patient with acquired torticollis. These findings suggest that integrating multiple therapeutic modalities can enhance treatment outcomes for musculoskeletal deformities.

Adrenergic relaxations in an in situ urinary bladder model evoked by stimulation of sensory pelvic and pudendal nerves in the rat

Urinary bladder dysfunction might be related to disturbances at different levels of the micturition reflex arc. The current study aimed to further develop and evaluate a split bladder model for detecting and analysing relaxatory signalling in the rat urinary bladder. The model allows for discrimination between effects at the efferent and the afferent side of the innervation. In in vivo experiments, the stimulation at a low frequency (1 Hz) of the ipsilateral pelvic nerve tended to evoke relaxation of the split bladder half (contralateral side; −1.0 ± 0.4 mN; n = 5), in contrast to high frequency-evoked contractions. In preparations in which the contralateral pelvic nerve was cut the relaxation occurred at a wider range of frequencies (0.5–2 Hz). In separate experiments, responses to 1 and 2 Hz were studied before and after intravenous injections of propranolol (1 mg/kg IV). The presence of propranolol significantly shifted the relaxations into contractions. Also, electrical stimulation of the ipsilateral pudendal nerve evoked relaxations of similar magnitude as for the pelvic stimulations, which were also affected by propranolol. In control in vitro experiments, substances with β-adrenoceptor agonism, in contrast to a selective α-agonist, evoked relaxations. The current study shows that the split bladder model can be used for in vivo studies of relaxations. In the model, reflex-evoked sympathetic responses caused relaxations at low intensity stimulation. The involvement of β-adrenoceptors is supported by the sensitivity to propranolol and by the in vitro observations.