Electrical Stimulation Research Articles

Acute stress promotes effort mobilization for safety-related goals

Although the acute stress response is a highly adaptive survival mechanism, much remains unknown about how its activation impacts our decisions and actions. Based on its resource-mobilizing function, here we hypothesize that this intricate psychophysiological process may increase the willingness (motivation) to engage in effortful, energy-consuming, actions. Across two experiments (n = 80, n = 84), participants exposed to a validated stress-induction protocol, compared to a no-stress control condition, exhibited an increased willingness to exert physical effort (grip force) in the service of avoiding the possibility of experiencing aversive electrical stimulation (threat-of-shock), but not for the acquisition of rewards (money). Use of computational cognitive models linked this observation to subjective value computations that prioritize safety over the minimization of effort expenditure; especially when facing unlikely threats that can only be neutralized via high levels of grip force. Taken together, these results suggest that activation of the acute stress response can selectively alter the willingness to exert effort for safety-related goals. These findings are relevant for understanding how, under stress, we become motivated to engage in effortful actions aimed at avoiding aversive outcomes.

Addressing Model Uncertainties in Finite Element Simulation of Electrically Stimulated Implants for Critical-Size Mandibular Defects.

Electrical stimulation is known to enhance bone healing. Novel electrostimulating devices are currently being developed for the treatment of critical-size bone defects in the mandible. Previous numerical models of these devices did not account for possible uncertainties in the input data. We present the numerical model of an electrically stimulated minipig mandible, including optimization and uncertainty quantification (UQ) methods that allow us to determine the most influential parameters. Uncertainties in the optimized finite element model are quantified using the polynomial chaos method that is implemented in the open-source Python toolbox Uncertainpy. The volumes of understimulated, beneficially stimulated, and overstimulated tissue are considered quantities of interest because they may significantly impact the expected healing success. Further, the current is a substantial quantity, limiting the lifetime of a battery-driven stimulation unit. With sensitivity analyses, the most critical parameters in the numerical model can be identified. Thus, we can learn which parameters are particularly relevant, for example, when conceptualizing the stimulation unit or planning the manufacturing process. The results of this study show that the parameters of the electrode-tissue interface (ETI), as well as the conductivity within the defect volume, have the most significant impact on the model results. The UQ results suggest that careful characterization of the ETI and the dielectric tissue properties is crucial to reduce these uncertainties. The numerical model regarding uncertainties yields important implications for reliable implant design and clinical translation.

Electrical Stimulation and Motor Function Rehabilitation in Spinal Cord Injury: A Systematic Review

Electrical Stimulation and Motor Function Rehabilitation in Spinal Cord Injury: A Systematic Review

Influence of stimulation frequency on brain-derived neurotrophic factor and cathepsin-B production in healthy young adults.

Electrical muscle stimulation (EMS) has been shown to stimulate the production of myokines (i.e., brain-derived neurotrophic factor (BDNF)), but the most effective EMS parameters for myokine production have not been fully elucidated. The purpose of this study was to quantify the optimal EMS frequency for stimulating myokine production. This study included sixteen young adults (male, n = 13, age = 27.3 ± 5.5 years). Participants underwent four EMS interventions (20min each) with the following conditions: (1) 4Hz, (2) 20Hz, (3) 80Hz, and (4) control (no intervention). Blood samples were obtained before and immediately after EMS. For the control condition, blood samples were taken before and after 20min of quiet sitting. BDNF and cathepsin-B levels were analyzed in serum. Compared to preintervention levels, stimulation at 20Hz resulted in significantly greater postintervention cathepsin-B and BDNF levels (p < 0.01). On the other hand, the control condition did not result in a significant change between pre- and posttreatment. Furthermore, stimulation at 20Hz caused significantly larger increases in cathepsin-B and BDNF levels than stimulation at 4-80Hz or the control condition (p < 0.05). In conclusion, stimulation at 20Hz effectively causes a robust cathepsin-B and BDNF response. Based on these results, we suggest a new strategy for rehabilitation of people with neurological disorders.

Stimulation of caudal inferior and middle frontal gyri disrupts planning during spoken interaction

Turn-taking is a central feature of conversation across languages and cultures.1,2,3,4 This key social behavior requires numerous sensorimotor and cognitive operations1,5,6 that can be organized into three general phases: comprehension of a partner's turn, preparation of a speaker's own turn, and execution of that turn. Using intracranial electrocorticography, we recently demonstrated that neural activity related to these phases is functionally distinct during turn-taking.7 In particular, networks active during the perceptual and articulatory stages of turn-taking consisted of structures known to be important for speech-related sensory and motor processing,8,9,10,11,12,13,14,15,16,17 while putative planning dynamics were most regularly observed in the caudal inferior frontal gyrus (cIFG) and the middle frontal gyrus (cMFG). To test if these structures are necessary for planning during spoken interaction, we used direct electrical stimulation (DES) to transiently perturb cortical function in neurosurgical patient-volunteers performing a question-answer task.7,18,19 We found that stimulating the cIFG and cMFG led to various response errors9,13,20,21 but not gross articulatory deficits, which instead resulted from DES of structures involved in motor control8,13,20,22 (e.g., the precentral gyrus). Furthermore, perturbation of the cIFG and cMFG delayed inter-speaker timing-consistent with slowed planning-while faster responses could result from stimulation of sites located in other areas. Taken together, our findingssuggest that the cIFG and cMFG contain critical preparatory circuits that are relevant for interactive language use.

Ibrutinib, a Bruton's tyrosine kinase inhibitor, regulates ventricular electromechanical activities and enhances arrhythmogenesis

BackgroundIbrutinib, a Bruton's tyrosine kinase inhibitor used in cancer therapy, exerts ventricular proarrhythmic effects; however, the underlying mechanisms remain unclear. Excitation-contraction coupling (E-C) disorders are pivotal for the genesis of ventricular arrhythmias (VAs), which arise mainly from the right ventricular outflow tract (RVOT). In this study, we aimed to comprehensively investigate whether ibrutinib regulates the electromechanical activities of the RVOT, leading to enhanced arrhythmogenesis, and explore the underlying mechanisms. MethodsWe utilized conventional microelectrodes to synchronously record electrical and mechanical responses in rabbit RVOT tissue preparations before and after treatment with ibrutinib (10, 50, and 100 nM) and investigated their electromechanical interactions and arrhythmogenesis during programmed electrical stimulation. The fluorometric ratio technique was used to measure intracellular calcium concentration in isolated RVOT myocytes. ResultsIbrutinib (10–100 nM) shortened the action potential duration. Ibrutinib at 100 nM significantly increased pacing-induced ventricular tachycardia (VT) (from 0% to 62.5%, n = 8, p = 0.025). Comparisons between pacing-induced VT and non-VT episodes demonstrated that VT episodes had a greater increase in contractility than that of non-VT episodes (402.1 ± 41.4% vs. 232.4 ± 29.2%, p = 0.003). The pretreatment of ranolazine (10 μM, a late sodium current blocker) prevented the occurrence of ibrutinib-induced VAs. Ibrutinib (100 nM) increased late sodium current, reduced intracellular calcium transients, and enhanced calcium leakage in RVOT myocytes. ConclusionIbrutinib increased the risk of VAs in the RVOT due to dysregulated electromechanical responses, which can be attenuated by ranolazine or apamin.

AI-powered Neuroprosthetics for brain-computer interfaces (BCIs)

Imagine a world where individuals with lost or impaired sensory or motor function can regain independence and control through technology. This is the promise of neuroprosthetics, a rapidly evolving field that bridges the gap between the nervous system and external devices. Neuroprosthetics encompass a range of implanted or external devices designed to: Substitute for a malfunctioning part of the nervous system. Assist in the recovery or enhancement of lost or impaired function. Augment existing capabilities, creating new possibilities. These devices interact with the nervous system using various methods, including: Electrical stimulation: Directly stimulating nerves or brain tissue to evoke desired responses. Recording brain activity: Capturing electrical signals generated by the brain for further processing and interpretation. Common applications of neuroprosthetics include: Cochlear implants: Restoring hearing in individuals with severe hearing loss. Deep brain stimulation (DBS): Treating movement disorders like Parkinson's disease and essential tremor. Bionic limbs: Providing control of prosthetic arms and legs for individuals with limb loss. Brain-computer interfaces (BCIs): Enabling communication and control of external devices using brain signals alone. Neuroprosthetics offer a glimpse into the future of medicine and technology. With ongoing advancements, these devices have the potential to revolutionize how we treat neurological conditions, restore lost abilities, and even enhance human potential. However, significant challenges remain, including ensuring long-term safety, improving accuracy and reliability, and addressing ethical considerations. As research continues, neuroprosthetics holds immense potential to improve the lives of millions and redefine what it means to be human. The integration of artificial intelligence (AI) with neuroprosthetics has marked a significant milestone in the development of brain-computer interfaces (BCIs). This emerging synergy aims to enhance the quality of life for individuals with disabilities by restoring lost sensory, motor, and cognitive functions. This review article explores the advancements in AI-powered neuroprosthetics for BCIs, focusing on their design, functionality, and the ethical considerations that accompany their integration into medical practice.

Electrical Stimulation Induces Activation of Mitochondrial Apoptotic Pathway and Down-Regulates Heat Shock Proteins in Pork: An Innovative Strategy for Enhancing the Ripening Process and Quality of Dry-Cured Loin Ham.

A fundamental regulatory framework to elucidate the role of electrical stimulation (ES) in reducing long production cycles, enhancing protein utilization, and boosting product quality of dry-cured ham is essential. However, how mitochondria and enzymes in meat fibers are altered by ES during post-processing, curing, and fermentation procedures remains elusive. This study sought to explore the impact of ES on the regulation of heat shock proteins (HSP27, HSP70), apoptotic pathways, and subsequent influences on dry-cured pork loin quality. The gathered data validated the hypothesis that ES notably escalates mitochondrial oxidative stress and accelerates mitochondrial degradation along the ripening process. The proapoptotic response in ES-treated samples was increased by 120.7%, with a cellular apoptosis rate 5-fold higher than that in control samples. This mitochondrial degradation is marked by increased ratios of Bax/Bcl-2 protein along the time course, indicating that apoptosis could contribute to the dry-cured ham processing. ES was shown to further down-regulate HSP27 and HSP70, establishing a direct correlation with the activation of mitochondrial apoptosis pathways, accompanied by dry-cured ham quality improvements. The findings show that ES plays a crucial role in facilitating the ripening of dry-cured ham by inducing mitochondrial apoptosis to reduce HSP expression. This knowledge not only explains the fundamental mechanisms behind myofibril degradation in dry-cured ham production but also offers a promising approach to enhance quality and consistency.

Effects of Intramuscular Electrical Stimulation for Treatment of Non-Traumatic Shoulder Pain

Non-traumatic shoulder pain is the third most common cause of consultations for musculoskeletal pain in primary health care. It is one of the common musculoskeletal conditions of the shoulder which may develop sensory-motor and autonomic dysfunctions at the various level of the neuromuscular system. The objective of the study to find out the Effects of Intramuscular Electrical Stimulation for Treatment of Non-Traumatic Shoulder Pain. The pain and dysfunction caused by NSP were primarily treated with physical therapy and pharmacological agents in order to achieve pain free movements. However, in recent years intramuscular electrical stimulation (IMES) with conventional electrode placement was used by researchers to maximize therapeutic values. But, in this study an inverse electrode placement was used to deliver electrical impulses intramuscularly to achieve neuro-modulation at the various level of the nervous system. Nine patients with NSP were treated with intramuscular electrode stimulation using inversely placed electrodes for a period of three weeks. All nine subjects recovered from their shoulder pain and disability within the few weeks of intervention. So, this IMES may be more appropriate for treatment approach for Non traumatic shoulder pain management.

Human enteric nervous system progenitor transplantation improves functional responses in Hirschsprung disease patient-derived tissue

ObjectiveHirschsprung disease (HSCR) is a severe congenital disorder affecting 1:5000 live births. HSCR results from the failure of enteric nervous system (ENS) progenitors to fully colonise the gastrointestinal tract during...

Maturation of Human iPSC-Derived Cardiac Microfiber with Electrical Stimulation Device.

Here an electrical stimulation system is described for maturing microfiber-shaped cardiac tissue (cardiac microfibers, CMFs). The system enables stable culturing of CMFs with electrical stimulation by placing the tissue between electrodes. The electrical stimulation device provides an electric field covering whole CMFs within the stimulation area and can control the beating of the cardiac microfibers. In addition, CMFs under electrical stimulation with different frequencies are examined to evaluate the maturation levels by their sarcomere lengths, electrophysiological characteristics, and gene expression. Sarcomere elongation (14% increase compared to control) is observed at day 10, and a significant upregulation of electrodynamic properties such as gap junction protein alpha 1 (GJA1) and potassium inwardly rectifying channel subfamily J member 2 (KCNJ2) (maximum fourfold increase compared to control) is observed at day 30. These results suggest that electrically stimulated cultures can accelerate the maturation of microfiber-shaped cardiac tissues compared to those without electrical stimulation. This model will contribute to the pathological research of unexplained cardiac diseases and pharmacologic testing by stably constructing matured CMFs.

Etiology and Management of 800 Patients With Facial Palsy at a Private Practice Setting Over a 5-Year Period.

Very few papers investigated the etiologic breakdown and demographic characteristics of patients with facial nerve (FN) palsy. Our paper aims to present the etiologic breakdown and demographic characteristics of patients with FN palsy, presenting at a private care center between 2014 and 2019, along with the treatment modalities that were offered to them. Charts of 800 patients with facial palsy (FP) were reviewed. Data included the etiology of their diagnosis, family history, recurrent FP, demographic information, and treatment provided before and after presentation. Seventy-five percent of our study population were females. The average period between diagnosis with FP and presentation at our center was 10.8 years. The most commonly identified etiology was Bell's palsy, followed by acoustic neuroma. Eighty-one percent of the study subjects were prescribed steroids and/or antivirals. Facial neuromuscular retraining, electrical stimulation, chemodenervation, and surgical intervention were also part of some treatment plans for our population. Recommendations for the treatment of idiopathic FP include steroids with adjuvant antiviral medications. Data remains uncertain whether the combination therapy of steroids and antivirals has better results compared to steroids alone. Electrical stimulation is still a controversial therapeutic tool for facial paralysis with a potential role in exacerbating synkinesis. The difference in referral patterns between tertiary and private care centers can explain the disparity in the ranking of the etiologies between our study and what has been published. Management of FP is a complex process. The FN community must develop a common database to improve its understanding of the different presentations.

The effect of bioelectric and manual impressions on quality of complete dentures and quality of life: A cross over pilot study

PurposeTo compare the quality of complete dentures and quality of life of participants rehabilitated by using TENS (Transcutaneous electric nerve stimulation) facilitated impression making with manual impressions. Material and methodsTen completely edentulous participants were enrolled in the crossover, pilot study. Participants were randomized in 2 groups. Five participants in each group were rehabilitated by dentures fabricated with TENS facilitated definitive impression technique (group T) and conventional impression technique (group C). In group T, Bioelectric border molding was done for the participants, that uses electric stimulation of the nerves supplying the muscles. In group C, incremental border molding using modeling plastic impression compound was carried out. Participants in each group used the dentures for 3 months. After 3 months, OHIP-EDENT questionnaire responses were obtained from the participants to observe the oral health related quality of life. A dental specialist recorded denture quality by Kapur scoring criteria. After one month wash period, the treatment was swapped between the groups. OHIP-EDENT scores and Kapur score were recorded for the alternate dentures after 3 months of use. Descriptive analysis was followed by Mann Whitney test to compare the overall scores between group T and group C for OHIP-EDENT, the scores for individual domains of OHIP-EDENT, and Kapur score for denture evaluation (α = 0.05). ResultsThe overall OHIP-EDENT scores within each domain were less in group T when compared with the scores in group C and Kapur score for group T was more than group C. The difference was statistically significant i.e. P = 0.002 & 0.003 respectively. ConclusionsLess OHIP-EDENT scores in group T imply better perception of quality of life of individuals due to better performance of stomatognathic system. The higher Kapur scores in group T signifies better quality of dentures when TENS was used for definitive impression making.

Temporal interference stimulation disrupts spike timing in the primate brain

Electrical stimulation can regulate brain activity, producing clear clinical benefits, but focal and effective neuromodulation often requires surgically implanted electrodes. Recent studies argue that temporal interference (TI) stimulation may provide similar outcomes non-invasively. During TI, scalp electrodes generate multiple electrical fields in the brain, modulating neural activity only at their intersection. Despite considerable enthusiasm for this approach, little empirical evidence demonstrates its effectiveness, especially under conditions suitable for human use. Here, using single-neuron recordings in non-human primates, we establish that TI reliably alters the timing, but not the rate, of spiking activity. However, we show that TI requires strategies—high carrier frequencies, multiple electrodes, and amplitude-modulated waveforms—that also limit its effectiveness. Combined, these factors make TI 80 % weaker than other forms of non-invasive brain stimulation. Although unlikely to cause widespread neuronal entrainment, TI may be ideal for disrupting pathological oscillatory activity, a hallmark of many neurological disorders.

Investigation of Motor Learning Effects Using a Hybrid Rehabilitation System Based on Motion Estimation.

Upper-limb paralysis requires extensive rehabilitation to recover functionality for everyday living, and such assistance can be supported with robot technology. Against such a background, we have proposed an electromyography (EMG)-driven hybrid rehabilitation system based on motion estimation using a probabilistic neural network. The system controls a robot and functional electrical stimulation (FES) from movement estimation using EMG signals based on the user's intention, enabling intuitive learning of joint motion and muscle contraction capacity even for multiple motions. In this study, hybrid and visual-feedback training were conducted with pointing movements involving the non-dominant wrist, and the motor learning effect was examined via quantitative evaluation of accuracy, stability, and smoothness. The results show that hybrid instruction was as effective as visual feedback training in all aspects. Accordingly, passive hybrid instruction using the proposed system can be considered effective in promoting motor learning and rehabilitation for paralysis with inability to perform voluntary movements.

Conservative Interventions for Urinary Incontinence on Postpartum Women: A Systematic Review and Meta-Analysis.

Urinary incontinence (UI) is common in postpartum women and can lead to a reduced quality of life and withdrawal from fitness and exercise activities. Conservative management interventions such as pelvic floor muscle training (PFMT), use of vaginal cones, and biofeedback have been recommended as first-line treatment. We aimed to explore the effects of conservative interventions on UI rate, severity, and incontinence-specific quality of life in postpartum women with UI. Nine databases were searched from inception to August 2022: PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, Wanfang, China National Knowledge Infrastructure, China Biological Medicine, and VIP Journal Integration Platform. Randomized controlled trials examining the effects of conservative interventions on postpartum UI were included. Initial searches produced 1839 results, of which 17 studies were eligible. All included studies had a low to moderate risk of bias. Supervised PFMT and use of a vaginal cone were more effective than individual PFMT in decreasing rates of UI (odds ratio, 0.29; 95% CI, 0.14-0.61). Individual PFMT combined with acupuncture (mean difference, -1.91; 95% CI, -2.46 to -1.37) or electroacupuncture and supervised PFMT combined with moxibustion were more effective than individual supervised PFMT alone in improving the severity of symptoms. Furthermore, electrical stimulation and biofeedback combined with acupoint stimulation or core training were more effective than electrical stimulation and biofeedback alone. For improving the incontinence-specific quality of life, supervised PFMT was more efficacious than individual PFMT; electrical stimulation and biofeedback plus core training were more beneficial than electrical stimulation and biofeedback alone. Supervised PFMT and use of a vaginal cone were more beneficial in decreasing rates of UI compared with individual PFMT. Superior effects in decreasing UI severity may be achieved by combining PFMT or electrical simulation and biofeedback with other therapies. Electrical stimulation and biofeedback plus core training, as well as supervised PFMT, are most effective in improving incontinence-specific quality of life. Further research is required to provide more evidence on the efficacy of these therapies.

Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome.

The objective of this study was to evaluate the efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome (CPPS). A total of 79 female patients diagnosed with CPPS from January 2021 to December 2022 were prospectively analyzed. Every patient received 3 weeks of treatment which included myofascial release therapy combined with electrical and magnetic stimulation. The visual analog score (VAS) of pelvic floor muscle (PFM) trigger points (TrPs) and the changes in pelvic floor surface electromyography before and after treatment were compared. Multiple linear regression was used to analyze the influencing factors of each outcome index. There were significant differences in VASs of muscle TrPs before and after treatment (P < 0.05). For the surface electromyography of PFMs, the differences in pre-baseline rest, post-baseline rest, isometric contractions for muscle endurance evaluation, and coefficient of variation were statistically significant (P < 0.05). Linear regression analysis showed that disease course (X 1), dyspareunia (X 5), and urinary incontinence (X 6) were influencing factors for the decline of pre-baseline rest (r5 = 1.067, R 2 = 0.089), post-baseline rest (r1 = 0.055, r5 = 0.99, R 2 = 0.119), VASs of ischial spine (r5 = 0.916, R 2 = 0.102), obturator internus (r5 = 0.796, r6 = -0.703, R 2 = 0.245), and pubococcygeus (r5 = 0.885, R 2 = 0.149) after treatment in the CPPS group. This study confirmed that individualized myofascial release therapy combined with electrical and magnetic stimulation has significant efficacy for patients with CPPS. At the same time, it is more effective for CPPS patients with longer course of disease, dyspareunia, and without urinary incontinence.

Radiofrequency and Electrical Muscle Stimulation: A Synergistic Treatment That Achieves Lipolysis and Circumferential Waist Reduction in Non-Invasive Body Contouring

Abstract Background Surgeons and providers in aesthetic medicine seek non-invasive devices that can be utilized for safe, efficient and effective body contouring. Patient demand has propelled the development of novel devices that can simultaneously improve skin laxity, adipolysis along with stimulation of muscle hypertrophy. Objectives To determine the efficacy of body contouring after three treatments using the non-invasive Transform (InMode, Lake Forest, CA) device. Methods A prospective, multi-center study was performed. Outcomes evaluated include: standardized caliper and ultrasound measurements of abdominal skin/soft tissue thickness, waist circumference, histologic evaluation, patient comfort and satisfaction assessments. Results Forty-four patients were successfully enrolled in the study and completed the series of three treatments which involved combined electrical muscle stimulation (EMS) and non-invasive bipolar radiofrequency (RF). Abdominal ultrasound measurements reveal a decrease in soft-tissue thickness (average 3.1mm; p=0.001), there was a significant decrease in caliper measurements of peri-umbilical skin thickness (p&amp;lt;0.003) and the average reduction of abdominal circumference was 1.9cm (p&amp;lt;0.0001) three months after the treatment series. Histology confirmed subcutaneous adipolysis without damaging the dermal layer. Patients reported a high degree of satisfaction with the overall result (p=0.003) and that each of the three treatments were progressively more comfortable (p&amp;lt;0.005). Conclusions This study demonstrates that a series of simultaneous non-invasive RF with EMS treatments to the abdomen decreases subcutaneous soft tissue thickness of the treated area. These comfortable treatments ultimately result in a high degree of patient satisfaction at three months.

Effectiveness of the Combination of Infrared Radiation (IRR) and Transcutaneous Electrical Nerve Stimulation (TENS) Interventions on the Functional Ability of Low Back Pain Farmers: A Quasi Experimental Study

Low back pain (LBP) is an acute or chronic pain that can be felt in the waist area or in the lumbosacral area. One way to deal with LBP complaints is to use infrared radiation (IRR) and transcutaneous electrical nerve stimulation (TENS). This study aims to analyze the effectiveness of the combination of IRR and TENS on the functional abilities of farmers with LBP. The quasi-experimental study was conducted on 84 respondents (intervention group n=42, control group n =42) who were purposefully recruited from March to April 2024. Variable measurement is done using the back pain functional scale questionnaire (BPFS). Paired T Test and Independent T test are used for data analysis. The results of the study showed that although both groups had an influence on the functional abilities of LBP farmers (p&lt;0,001), in the intervention group it was shown to improve the functional abilities scores of farmers with lBP compared to the control group (15.64 vs 13.29). It is recommended to farmers to carry out IRR and TENS therapeutic measures according to the functional scale of LBP, and it is also advised to healthcare professionals at the public health center to be able to establish cooperation with the parties concerned to organize the treatment program of LBP on farmers using the combination of IRR and TENS.

Effects of Adding Four Sessions of Ultrasound-Guided Percutaneous Electrical Nerve Stimulation to an Exercise Program in Patients with Shoulder Pain: A Randomized Controlled Trial.

Objective: Percutaneous electrical nerve stimulation (PENS) appears to be effective for the treatment of musculoskeletal pain. The aim of this trial was to investigate the effects on disability and pain, as well as on the psychological aspects of adding PENS into an exercise program in patients with subacromial pain syndrome. Methods: A randomized, parallel-group clinical trial was conducted. Sixty patients with subacromial pain were allocated into exercise alone (n = 20), exercise plus PENS (n = 20), or exercise plus placebo PENS (n = 20) groups. Patients in all groups performed an exercise program twice daily for 3 weeks. Patients allocated to the PENS group also received four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves. Patients allocated to the exercise plus placebo PENS received a sham PENS application. The primary outcome was related disability (Disabilities of the Arm, Shoulder, and Hand, DASH). Secondary outcomes included mean pain, anxiety levels, depressive symptoms, and sleep quality. They were assessed at baseline, one week after, and one and three months after. An analysis was performed using intention-to-treat with mixed-models ANCOVAs. Results: The results revealed no between-group differences for most outcomes (related disability: F = 0.292, p = 0.748, n2p = 0.011; anxiety: F = 0.780, p = 0.463, n2p = 0.027; depressive symptoms: F = 0.559, p = 0.575, n2p = 0.02; or sleep quality: F = 0.294, p = 0.747, n2p = 0.01); both groups experienced similar changes throughout the course of this study. Patients receiving exercise plus PENS exhibited greater improvement in shoulder pain at one month than those in the exercise (Δ -1.2, 95%CI -2.3 to -0.1) or the placebo (Δ -1.3, 95%CI -2.5 to -0.1) groups. Conclusions: The inclusion of four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves into an exercise program did not result in better outcomes in our sample of patients with subacromial pain syndrome at one and three months after treatment.