Low-frequency Transcutaneous Electrical Nerve Stimulation Research Articles

Transcutaneous electrical nerve stimulation (TENS) for pain control in women with primary dysmenorrhoea.

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological treatment that works by delivering electrical currents via electrodes attached to the skin at the site of pain. It can be an alternative to pharmacological treatments. The mechanism of action of TENS for pain relief is related to the inhibition of the transmission of painful stimuli, release of endogenous opioids, and reduced muscle ischaemia of the uterus. Although it has been used for primary dysmenorrhoea ((PD); period pain or menstrual cramps), evidence of the efficacy and safety of high-frequency TENS, low-frequency TENS, or other treatments for PD is limited. To evaluate the effectiveness and safety of transcutaneous electrical nerve stimulation (TENS) in comparison with placebo, no treatment, and other treatments for primary dysmenorrhoea (PD). We searched the Gynaecology and Fertility Group's Specialized Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, and the Korean and Chinese language databases up to 9 April 2024. We also searched for ongoing trials in trials registries and the reference lists of relevant studies for additional trials. Language restrictions were not applied. We included randomized controlled trials (RCTs) that included women (aged 12 to 49 years) with PD. Included trials compared low-frequency TENS or high-frequency TENS with other TENS, placebo, or other treatment. Four review authors screened the trials, extracted the data according to the protocol, assessed the risk of bias using RoB 2, and assessed the certainty of evidence for all review comparisons and primary outcomes (i.e. pain relief and adverse effects) using the GRADE approach. This review replaces the current review, published in 2009. We included 20 RCTs involving 585 randomized women with high-frequency TENS, low-frequency TENS, placebo or no treatment, or other treatment. We included five comparisons: high-frequency TENS versus placebo or no treatment, low-frequency TENS versus placebo or no treatment, high-frequency TENS versus low-frequency TENS, high-frequency TENS versus other treatments, and low-frequency TENS versus other treatments. High-frequency TENS versus placebo or no treatment High-frequency TENS may reduce pain compared with placebo or no treatment (mean difference (MD) -1.39, 95% confidence interval (CI) -2.51 to -0.28; 10 RCTs, 345 women; low-certainty evidence; I2 = 88%). Two out of three RCTs reported no adverse effects and hence we were unable to estimate the effect of high-frequency TENS on adverse effects. Low-frequency TENS versus placebo or no treatment Low-frequency TENS may reduce pain compared with placebo or no treatment (MD -2.04, 95% CI -2.95 to -1.14; 3 RCTs, 645 women; low-certainty evidence; I2 = 0%). No trials reported adverse effects for this comparison. High-frequency TENS versus low-frequency TENS It is uncertain whether high-frequency TENS had an effect on pain relief compared with low-frequency TENS (MD 0.89, 95% CI -0.19 to 1.96; 3 RCTs, 54 women; low-certainty evidence; I2 = 0%). One trial contributed data on adverse effects but no adverse events occurred. High-frequency TENS versus other treatments It is uncertain whether high-frequency TENS had an effect on pain relief compared to acupressure (MD -0.66, 95% CI -1.72 to 0.40; 1 RCT, 18 women; very low-certainty evidence), acetaminophen (paracetamol) (MD -0.98, 95% CI -3.30 to 1.34; 1 RCT, 20 women; very low-certainty evidence), and interferential current therapy (MD -0.03, 95% CI -1.04 to 0.98; 2 RCTs, 62 women; low-certainty evidence; I2 = 0%). The occurrence of adverse effects did not differ significantly between high-frequency TENS and NSAIDs (OR 12.06, 95% CI 0.26 to 570.62; 2 RCTs, 88 women; low-certainty evidence; I2 = 78%). Low-frequency TENS versus other treatments It is uncertain whether low-frequency TENS had an effect on pain relief compared with acetaminophen (MD -1.48, 95% CI -3.61 to 0.65; 1 RCT, 20 women; very low-certainty evidence). No trials reported adverse effects for this comparison. High-frequency TENS and low-frequency TENS may reduce pain compared with placebo or no treatment. We downgraded the certainty of the evidence because of the risk of bias. Future RCTs should focus more on secondary outcomes of this review (e.g. requirement for additional analgesics, limitation of daily activities, or health-related quality of life) and should be designed to ensure a low risk of bias.

Low-Frequency TENS in Women With Behavioral Dysphonia: Preliminary Data From a Randomized Clinical Trial

Low-Frequency TENS in Women With Behavioral Dysphonia: Preliminary Data From a Randomized Clinical Trial

Changes in Heart Rate Variability During Low-Frequency Transcutaneous Electrical Nerve Stimulation in Athletes with Acute Musculoskeletal Injury

Background: Pain is a relevant clinical symptom to ask for medical management. Since pain is a subjective sensation, its intensity is difficult to precisely assess. Objectives: The present study aimed to determine whether heart rate variability (HRV) can be a potential parameter to evaluate the pain-relieving effect of low-frequency transcutaneous electrical nerve stimulation (TENS). Methods: Athletes with lower limb musculoskeletal injuries were voluntarily included in the study. Pressure pain thresholds (PPT) was measured immediately after the intervention, and 24 hours after the treatment. Heart rate variability was also determined from electrocardiography (ECG) monitoring throughout the intervention. Results: The HRV of 25 participants revealed that 30 minutes of low-frequency electrical stimulation immediately increased PPT (before = 2.67 ± 0.79; after = 2.92 ± 0.90, P = 0.011). Thirteen participants had more than a 10% increase in PPT after the intervention; nevertheless, three participants had a decrease in PPT. The PPT was returned to the baseline 24 hours after the intervention. Electrocardiography demonstrated that only the frequency domain of low frequency-high frequency (LF/HF) ratio was significantly increased after the intervention (before = 1.454 ± 0.739; after = 1.922 ± 1.378; P = 0.035) but not time-domain HRV. Time-domain HRV significantly decreased during the intervention before returning to the baseline. The correlation between the change in PPT is mostly correlated with LF/HF. Conclusions: Heart rate variability revealed the potential change in sympathovagal balance toward the sympathetic domain during low-frequency TENS intervention. The frequency-domain LF/HF ratio was the most sensitive parameter to be affected by pain.

The effect of TENS on sleep: A pilot study

BackgroundInsomnia is the second most common neuropsychiatric disorder, but the current treatments are not very effective. There is therefore an urgent need to develop better treatments. Transcutaneous electrical nerve stimulation (TENS) may be a promising means of treating insomnia. ObjectiveThis work aims to explore whether and how TENS modulate sleep and the effect of stimulation waveforms on sleep. MethodsForty-five healthy subjects participated in this study. Electroencephalography (EEG) data were recorded before and after four mode low-frequency (1 Hz) TENS with different waveforms, which were formed by superimposing sine waves of different high frequencies (60–210 Hz) and low frequencies (1–6 Hz). The four waveform modes are formed by combining sine waves of varying frequencies. Mode 1 (M1) consists of a combination of high frequencies (60–110 Hz) and low frequencies (1–6 Hz). Mode 2 (M2) is made up of high frequencies (60–210 Hz) and low frequencies (1–6 Hz). Mode 3 (M3) consists of high frequencies (110–160 Hz) and low frequencies (1–6 Hz), while mode 4 (M4) is composed of high frequencies (160–210 Hz) and low frequencies (1–6 Hz). For M1, M3 and M4, the high frequency portions of the stimulus waveforms account for 50%, while for M2, the high frequency portion of the waveform accounts for 65%. For each mode, the current intensities ranged from 4 mA to 7 mA, with values for each participant adjusted according to individual tolerance. During stimulation, the subjects were stimulated at the greater occipital nerve by the four mode TENS. ResultsM1, M3, and M4 slowed down the frequency of neural activity, broadened the distribution of theta waves, and caused a decrease in activity in wakefulness-related regions and an increase in activity in sleep-related regions. However, M2 has the opposite modulation effect. ConclusionThese results indicated that low-frequency TENS (1 Hz) may facilitate sleep in a waveform-specific manner. Our findings provide new insights into the mechanisms of sleep modulation by TENS and the design of effective insomnia treatments.

Efficacy of transcutaneous electroneurostimulation in treatment of erectile dysfunction associated with Covid-19

Background: Many studies provide data on the development of erectile dysfunction in patients after COVID-19. In most cases, the authors associated this complication with depression. However, in rare cases, erectile dysfunction is organic in nature as a result of pudendal neuropathy. Materials and methods: We examined 29 patients with the development of sexual erectile dysfunction after COVID-19. In all patients, entrapment of the pudendal nerve was detected using pudendal evoked potentials and needle electromyography of pelvic floor. All patients underwent standard medical therapy for the treatment of sexual dysfunction after recovery from COVID-19. In addition to drug therapy, 9 patients underwent TENS of the pudendal nerve using monophasic square wave pulses with a frequency of 1 Hz and a duration of 100 μs with small amplitude below the threshold of sensory fibers (sham-TENS group). 10 patients underwent the same impulses with a frequency of 1 Hz and a duration of 100 μs with amplitude higher threshold level of sensory fibers (low-frequency TENS group), and 10 patients underwent TENS with frequency of 100 Hz and duration of 100 μs with amplitude higher threshold level of sensory fibers (high-frequency TENS group). International Index of Erectile Function questionnaire, QLS-H (Questions on Life Satisfaction), pudendal somatosensory evoked potentials, and needle electromyography of pelvic floor were used before and after treatment. Results: In patients after direct TENS of the pudendal nerve, erectile function improved in high-frequency TENS group and in low-frequency TENS group by 56 % and 27 % respectively. A remarkable increase in the quality of life satisfaction was noted by 95 % of patients after high-frequency TENS and by 35 % of patients after low-frequency TENS. There were no significant changes in erectile function and quality of life satisfaction in patients after sham stimulation. Partial recovery of latency and amplitudes of pudendal somatosensory evoked potentials N1 N2 was recorded in 6 patients only after high-frequency TENS. Conclusion: Direct high-frequency TENS of pudendal nerve is highly effective in treatment of erectile dysfunction associated with COVID-19. The high-frequency TENS proved 2 times more efficient than the low-frequency TENS. Notably, positive neurophysiological dynamics, determined using needle electromyography of the pelvic floor and pudendal somatosensory evoked potentials, was detected only against the background of high-frequency TENS.

Comparative Effect of Vagal Stimulation on Heart Rate, Blood Pressure, and Skin Hydration at Different Anatomical Sites in Prehypertensive Individuals: A Pilot Study

Introduction: Prehypertension is the precursor to high Blood Pressure (BP), which can lead to severe consequences such as cardiovascular disease, stroke, acute myocardial infarction, heart failure, peripheral arterial disease, and cerebrovascular complications, ultimately resulting in mortality. Vagal stimulation is frequently employed by therapists, along with various therapeutic exercises, to treat or manage Heart Rate (HR) and BP in prehypertensive individuals. The vagus nerve plays a vital role in maintaining internal physiological balance, known as homeostasis, which includes reflex pathways that regulate cardiac function. Auricular neuromodulation of the vagus nerve can be achieved through stimulation of the ear lobule, cymba concha, or tragus in the outer ear. Aim: To compare and determine the optimal anatomical site for vagal stimulation, specifically the ear lobule, cymba concha, or tragus, to improve HR, BP, and skin hydration in prehypertensive individuals. Materials and Methods: The present pilot study conducted a pre-post comparative analysis in the Outpatient Department (OPD) of Physiotherapy at the Institute of Applied Medicines and Research Centre, Ghaziabad, Uttar Pradesh, India. The study duration was nine months, from January 2022 to September 2022. A total of 30 subjects aged 30-55 years were divided into three groups (10 participants in each group: A, B, and C) using sealed envelopes. Group A received vagal stimulation on the ear lobule, Group B received vagal stimulation on the cymba concha, and Group C received vagal stimulation on the tragus. Baseline measurements were taken prior to treatment, including HR, BP, and skin hydration. Vagal stimulation was administered using a low-frequency Transcutaneous Electrical Nerve Stimulation (TENS) machine at 25 Hertz and a pulse width of 120 ms. The stimulus was continuously applied for 30 minutes, five days a week, for four weeks. After a 10-minute relaxation period, HR, BP, and skin hydration were measured both pre and post-intervention. The data was statistically analysed using Statistical Package for Social Sciences (SPSS) version 24.0, employing paired t-tests to compare means within groups and Analysis of Variance (ANOVA) to compare between the three groups. Results: There were no statistical differences in the baseline among all three groups. Group C, which received vagal stimulation on the tragus, demonstrated statistically significant improvements in BP and skin hydration. The t-value and p-value for Systolic Blood Pressure (SBP) were 11.513 and p<0.001, for Diastolic Blood Pressure (DBP) were 10.411 and p<0.001, for HR were 15.231 and p<0.001, and for skin hydration were 9.474 and p<0.001, respectively. When comparing HR, BP, and skin hydration among the groups using one-way ANOVA f- value and p-value showed significant difference between the groups in all parameters. Conclusion: The study concludes that vagal stimulation on the tragus is a superior intervention compared to vagal stimulation on the cymba concha or ear lobule for controlling HR, BP, and skin hydration in prehypertensive individuals.

The influence of the low-frequency transcutaneous electrical nerve stimulation application moment in vocal quality of dysphonic women

Objective: to compare the immediate effects of low-frequency TENS employment on vocal quality in women with behavioral dysphonia before and after vocal exercises. Methodology: 30 women (mean = 31.3 years old), diagnosed with behavioral dysphonia received low-frequency TENS before (TENS + VE Group) and after vocal exercises (VE + TENS Group) with a 1-week washout. They had their sustained vowel/a/and running speech recorded before and after each procedure for auditory-perceptual analysis and acoustic measures. The low-frequency TENS parameters applied were symmetrical biphasic quadratic pulse, 200 µs phase, 10 Hz frequency, intensity on the motor threshold, and the electrodes were positioned on the submandibular and superior fibers of the trapezius muscle region. The vocal exercises: tongue trill, humming, finger kazoo, and water resistance therapy were performed totalizing 20 min. Results: intragroup analysis of sustained vowel/a/showed reduction in both groups of strain parameter and increased the breathiness; only VE + TENS Group increased the instability parameter, decreased fundamental frequency, and increased in SPI values; the running speech analysis showed an increase in the overall degree, roughness, and breathiness parameters. However, in VE + TENS Group, there was a statistically significant decrease in the intensity of the strain and an increase in breathiness. The acoustic measures showed that VE + TENS Group had a higher variation than TENS + VE Group regarding NHR. Conclusion: vocal exercises followed by low-frequency TENS have more immediate positive effects on voice quality than the low-frequency TENS followed by vocal exercises. This is a preliminary immediate effects study, and these effects could be verified through long-term assessments.

Can Vocal Therapy With Transcutaneous Electrical Nerve Stimulation (TENS) Followed by Vocal Exercises Reduce Benign Laryngeal Lesions in Dysphonic Women?: Randomized, Blind Clinical Trial

To investigate the effectiveness of vocal therapy with the use of low-frequency transcutaneous electrical nerve stimulation (TENS) followed by voice exercises on vocal fold lesion size, vocal quality and quality of life in dysphonic women. 27 women with vocal nodules participated, randomized into to: experimental group (EG)-13 women who received vocal therapy with 12 sessions of 20 min of TENS application (pulse:200μs, frequency:10Hz, motor threshold intensity, electrodes positioned in the trapezius muscle [descending fibers and submandibular region, bilaterally]). Each TENS session was followed by 30 min of vocal exercises; and the Control Group (CG)- 14 women who received 12 sessions with 20 min of application of placebo TENS (same conditions EG, but without receiving the stimulus electric), followed by 30 min of vocal exercise. Before, immediately after and one month after vocal therapy, participants underwent vocal recording for acoustic analysis, vocal self-assessment, laryngological examination and answered voice-related quality of life (V-RQOL) protocol. There was reduction in the size of vocal fold lesions only in the EG, immediately after treatment and one month after treatment. Acoustic analysis showed decreases in SPI values immediately after and one month after treatment in both groups. There was improvement in voice self-perception in both groups after treatment and one month after, but no significant difference in V-RQOL values. TENS followed by vocal exercises produced results similar to vocal therapy without TENS regarding voice quality, self-perception and quality of life in voice. However, vocal therapy with low-frequency TENS followed by vocal exercise was effective in reducing vocal fold lesion size in dysphonic women.

Analgesic effects of high-frequency and low-frequency TENS currents in patients with distal neuropathy.

Currently, diabetes mellitus (DM) is relevant problem, both for its prevalence and complications, including distal polyneuropathy (DPNP). At the same time, discussions continue on analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) in DPNP. Aim of this study was to conduct a multi-faceted assessment of pain syndrome in these patients before and after TENS, taking into account levels of polyneuropathy, its severity and age of patients. The study was conducted in accordance with the research of the Federal State Budgetary Institution of the National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation (CTR No. 121040100062-3) and with the permission of the Local Ethics Committee (IRB No. 2 dated 14.01.2021). The study included 75 patients with DM type II with DPNP, which are distributed into 3 groups of 25 people: Group 1a, patients received high–frequency TENS (HF); Group Ib, patients received low-frequency TENS (LF); as control, Group C received a standard method of pharmacological therapy without physiotherapy. Intensity of DPNP was evaluated before and after the course of treatment using a visual analog scale (VAS), the McGill Pain Questionnaire (MPQ), and a graphical linear analysis of pain on the neuropathic pain diagnostic questionnaire 4 (DN4) scale. TENS provides an analgesic effect that may exceed pharmacotherapy in terms of efficacy and safety. There was a 65.9% reduction in neuropathic pain according to VAS after a course of application, with the effects remaining up to 34% during the 6-month follow-up. HF TENS provided a higher significant analgesic effects than LF TENS, as it ensures the reduction of pain syndrome according to VAS by 25.8% (p <0.01), and total estimated characteristics - 35.5% (p <0.01), and touch - in at 58.1% (p = 0.001) and according to the scales of the MPQ (S) and DN4 - by 21% (p = 0.007). The observed differences in analgesic effects between HF TENS and LF TENS are based on analyses of pain in the immediate and long-term follow-up periods of type II DM patients with DPNP. These results, based on summation of the estimated parameters of the international pain scales support expectation of an expansion of the the use of analgesic TENS in aging patients suffering with DM of varying severity and extent of DPNP damage, a goal of great scientific and practical importance.

Age-Limited Effects of Low-Frequency Transcutaneous Electric Nerve Stimulation on Insomnia: A 4-Week Multi-Center, Randomized Controlled Study.

Objective Insomnia disorder is a common condition with considerable harmful effects on health. We investigated the therapeutic efficacy and safety of low-frequency transcutaneous electric nerve stimulation (LF-TENS) as an alternative treatment option for insomnia disorder. Methods A 4-week, multi-center, randomized controlled study was conducted. A total of 160 individuals aged 40 to 80 years with insomnia disorder were included and randomized to the experimental group receiving active device (n=81) or control group receiving sham device (n=79). Both groups used the device for four weeks, more than five days a week. The participants also completed pre- and post-intervention assessment with questionnaires, sleep diaries, wrist actigraphy, and blood tests. Results There was no significant between-group difference in the changes of mood and sleep parameters and blood test results among the two study groups. Meanwhile, in the exploratory sub-group analysis of patients aged over 60 years, the experimental group showed better improvement after intervention in the change of Pittsburgh Sleep Quality Index (PSQI) score (-2.63±3.25 vs. -1.20±2.28, p=0.039; Cohen’s d=0.99 vs. 0.45) and blood cortisol level (-1.65±3.37 μg/dL vs. -0.16±3.49 μg/dL, p=0.007; Cohen’s d=0.56 vs. 0.05). In addition, no serious adverse reaction occurred during the study period in both groups. Conclusion The effect of LF-TENS was limited to older patients aged over 60 years, which might be related to the modulation of hypothalamic-pituitary-adrenal axis activity.

Clinical Experience of High Frequency and Low Frequency TENS in Treatment of Diabetic Neuropathic Pain in Russia.

Background: Transcutaneous electrical nerve stimulation (TENS) is presently one of the main methods of treatment for neuropathic pain in type II diabetes mellitus. The discussion about which TENS frequency is more effective in the treatment of neuropathic pain has been ongoing for many years. Despite this, the response of different aspects of neuropathic pain to various TENS modalities has not been sufficiently studied. Aim: To analyze changes in characteristics of neuropathic pain depending on the frequency of TENS. Materials and methods: Seventy-five Russian diabetic patients with painful distal axonal neuropathy were enrolled in the study. Patients were assigned to three groups: in the HF TENS group, 25 patients received standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin) + high-frequency TENS (HF); in the LF TENS group, 25 patients received standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin) + low-frequency TENS (LF); in the control group, 25 patients underwent just standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin). Pain intensity was calculated before and after treatment with visual analogue scale (VAS), McGill pain questionnaire (MPQ), Douleur Neuropathique 4 Questions (DN4) and Pain Drawing. Results: TENS increased the therapeutic effect of standard drug therapy, in the treatment of neuropathic pain, by 65.9% and prolonged its efficacy by 31% for up to 6 months after treatment. HF TENS had a more pronounced analgesic effect than LF TENS based on VAS (34.7%), sensory (57.6%) MPQ dimensions and DN4 (21%). Affective MPQ dimension with the use of LF TENS was lower than HF TENS by 34.7% immediately after treatment, by 47.3% after 2 months and by 34.8% after 6 months of the follow-up period. Conclusion: There are significant differences between HF and LF TENS based on pain assessment using various pain scales. This reflects the distinctive effects of different TENS modalities on different aspects of neuropathic pain.

ASSESSMENT OF PAIN CONTROL DURING SEPARATORS PLACEMENT USING TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION DEVICE (TENS) : A SPLIT – MOUTH STUDY (Research Article)

AIM : To assess the level of pain control achieved using transcutaneous electric nerve stimulation device (TENS) during orthodontic elastomeric separator placement. Methods : Ninety subjects were randomly assigned to three groups, the first group received low-frequency TENS and placebo, the second group received high-frequency TENS and placebo, the third group received high- and low-frequency TENS respectively. In each group, elastomeric separators were placed mesial and distal to the maxillary first molar in both the quadrants. A scientific medical system TENS was used to deliver the electric current. A visual analogue scale (VAS) was used to evaluate the pain. Result : There was a statistically significant difference correlation between TENS group and control group. No statistically significant results between high and low frequency TENS group. Conclusion: The present study suggests that orthodontic separator pain can be effectively reduced by TENS, either at high frequency or at low frequency.

Comparative analysis of labile and stable high-frequency TENS in the treatment of neuropathic pain syndrome

Introduction: There have been many works devoted to the comparative analysis of high-frequency and low-frequency TENS in the treatment of neuropathic pain syndrome. Meanwhile, the comparative analysis of the methods of labile and stable TENS has not been sufficiently studied to date. Purpose: To make a comparative analysis of labile and stable high-frequency TENS in the treatment of neuropathic pain syndrome in patients with distal polyneuropathy of the lower extremities (DPLE). Materials and methods: 64 patients (F: 34, M: 30) with severe neuropathic pain syndrome on the background of diabetic DPLE were studied. Depending on the method of high-frequency TENS, all patients were divided into 2groups: stable high-frequency TENS (n=31) and labile high-frequency TENS (n=33). TENS was carried out every other day for a month. The severity of pain was determined by the VAS before each procedure. Results: The reduction of pain syndrome with the use of labile stimulation was 76.9%, compared to stable stimulation — 41,6%. With daily registration of pain syndrome, a significant increase in pain syndrome was revealed in patients who underwent stable high-frequency TENS after the 7th procedure to 4,5±0,3points in comparison with the indicators of pain syndrome obtained after the 3rd procedure (3,2±0,14). Conclusions: The analgesic effect of the labile high-frequency TENS significantly exceeds the analgesic effect of the stable high-frequency TENS by 85.1%. Partial tolerance to high-frequency TENS is observed when applying stable stimulation, which develops after the 7th procedure and is not observed after labile TENS.

The dynamics of allodynia in the treatment of patients with diabetic polyneuropathy using transcutaneous electroneurostimulation

BACKGROUND: Allodynia, hyperalgesia, and positive sensory symptoms are the main symptoms of neuropathic pain. Studying these symptoms and their dynamics in the treatment of neuropathic pain broadens our understanding of neuropathic pain and how it can be treated.&#x0D; AIMS: To study the effect of different TENS modalities on allodynia in patients with severe neuropathic pain syndrome developed against the background of diabetic distal polyneuropathy of the lower extremities.&#x0D; MATERIAL AND METHODS: 75 patients with allodynia on the background of distal polyneuropathy of the lower extremities (DPLE) were treated with pharmacotherapy (n=26), high-frequency TENS (n=25), and low-frequency TENS (n=24).&#x0D; RESULTS: Immediately after treatment, we observed a more pronounced decrease in allodynia after the application of high-frequency TENS (by 72.2%) and low-frequency TENS (by 61.1%). Moreover, in the control group, the regression of allodynia averaged 28.6%. At the 2nd month of the long-term period, the severity of allodynia continued to decrease more rapidly against the background of high-frequency TENS (26.7%) than after low-frequency TENS (19%) and remained without significant dynamics against the background of pharmacotherapy.&#x0D; CONCLUSION: The use of TENS 1.3 times enhances the therapeutic effect of pharmacotherapy in treatment of neuropathic pain in patients with diabetic DPLE. High-frequency TENS is more effective than low-frequency TENS in the treatment of allodynia by 18.2% immediately after treatment and by 40% at the end of the 2nd long-term period. By the 6th month of the long-term period, the results of treatment in both groups did not differ significantly.

Low-Frequency Intravesical Electrical Stimulation for the Treatment of Acute Urinary Retention: A Promising Therapeutic Approach.

Acute urinary retention (AUR) is a troublesome urological disease, which causes various lower urinary tract symptoms. However, only few studies explored and evaluated the effective treatments to improve AUR. We aimed to find an effective approach to cure AUR through comparing the efficacy of existing classical low-frequency transcutaneous electrical nerve stimulation (TENS) and novel intravesical electrical stimulation (IVES). A total of 24 AUR female rats were divided into 3 groups as follows: control, TENS, and IVES groups. Rats in the control group had no fake stimulation. Rats in the TENS and IVES groups underwent transcutaneous or intravesical stimulation of a symmetrical biphasic rectangular current pulse with a frequency of 35 Hz, 30 min per day, for seven consecutive days. IVES significantly reduced the actin expression in the submucosal layer but increased its expression in the detrusor layer (p = 0.035, p = 0.001). The neovascularization in the submucosal layer in the IVES group was significantly increased than in the other 2 groups (p = 0.006). Low-frequency IVES performed better than TENS in terms of simultaneously relieving bladder hyperactivity, accelerating epithelial recovery, and strengthening detrusor muscle. IVES may be a promising therapeutic approach for bladder dysfunction, specifically for AUR and overactive bladder in clinical practice.

Efficiency of Acupuncture and Transcutaneous Electroneurostimulation in Treatment of Patients with Anxiety Disorders

Introduction: The effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of Anxiety disorders (AD) compared with standard pharmacotherapy and acupuncture was demonstrated in rare clinical research studies. Objective: To study the dynamics of anxiety disorders with the use of a direct TENS and acupuncture. Materials and Methods: 59 patients with AD were examined. 12 patients underwent only pharmacotherapy. 12 patients underwent low-frequency high-amplitude TENS (LH TENS) of the right median nerve. 11 patients have been treated by highfrequency low-amplitude (HL TENS) of the right median nerve. 12 patients received a course of LH TENS of the right tibial nerve. 12 patients underwent course of acupuncture. Results: GAD-7 shows that the decrease in the severity of anxiety disorders was most of all after acupuncture and averaged 47.9%, in second place - after LH TENS of the median nerve and averaged 44±3%, in third place - after LH TENS of the tibial nerve and averaged 30.2±5 %, in fourth place after HL TENS of the median nerve (14±6%) and least of all after only use of pharmacotherapy (17.2±5%). There was a significant improvement in the quality of life identified using SF-36 by 37% in patients after acupuncture, by 35% in patients after LH TENS of the median nerve, by 20% in patients after LH TENS of the tibial nerve, by 11% in patients after HL TENS of the median nerve and by 13% after pharmacotherapy. Conclusion: Acupuncture proved to be more effective than LH TENS of the median nerve in treating AD. At the same time, improving the quality of life has the same results in the two methods of treatment. Direct LH TENS is more effective than direct HL TENS in the treatment of patients with anxiety disorders. Stimulation of the median nerve was found to be more effective than stimulation of the tibial nerve by 66% in decreasing anxiety disorders and by 75% in improving quality of life.

Effects of Acupressure and Acupuncture-Like Transcutaneous Electrical Nerve Stimulation on Sleep Quality Among Pregnant Women

BackgroundDespite the adverse consequences of poor sleep during pregnancy, relatively few safe interventions exist for improving sleep among pregnant women. Nonpharmacological interventions are increasingly gaining acceptance. However, the effects of acupressure and acupuncture-like transcutaneous electrical nerve stimulation (ACUTENS) have not been widely reported. ObjectivesThe purpose of this study is to investigate the effects of low-frequency transcutaneous electrical nerve stimulation, otherwise known as ACUTENS, and acupressure on sleep quality among pregnant women. MethodsPurposive sampling of 42 pregnant women with sleep disorders was conducted, and the participants were randomized into 3 groups, i.e., acupressure, ACUTENS, and usual care. interventions, which were carried out twice weekly for six weeks. The Pittsburgh Sleep Quality index was used to determine the overall sleep quality. ResultsThe preintervention scores of sleep quality were 12.5 (3.75), 12.5 (4.0), and 13.0 (3.5) in the ACUTENS, acupressure, and usual care groups, respectively. The Kruskal–Wallis test did not show any significant difference in the preintervention sleep quality scores (H = 0.379, p = 0.827). Participants in the usual care group recorded the least improvement, with a score of 5.0 (2.25), the ACUTENS group recorded a score of 4.5 (3.0), and the greatest improvement was recorded in the acupressure group, with a score of 4.0 (2.2) after 6 weeks of intervention. The Kruskal–Wallis test did not show any significant difference in the postintervention sleep quality scores among the 3 groups (H = 0.666, p = 0.717). ConclusionThis study showed that ACUTENS and acupressure as an adjunct to usual care are not more effective than usual care alone in improving sleep quality among pregnant women.

Effectiveness of Low-Frequency Stimulation in Proprioceptive Neuromuscular Facilitation Techniques for Post Ankle Sprain Balance and Proprioception in Adults: A Randomized Controlled Trial.

Stretching is an important part of post ankle sprain rehabilitation, as well as an effective exercise for improving general ankle-joint performance. But the combination of stretching alongside low-frequency stimulation has not yet been extensively studied. Therefore, the purpose of the present randomized controlled trial was to compare the combined effects of low-frequency transcutaneous electrical nerve stimulation (TENS) with proprioceptive neuromuscular facilitation (PNF) on strength, balance, and proprioception among individuals with post ankle sprain. Sixty male subjects with lateral ankle sprain were selected and randomly allocated to three groups: group 1, group 2, and the control group (CG). Subjects in group 1 received the PNF stretching technique combined with TENS. TENS stimulation was provided using two electrodes placed 5 cm apart directly on the triceps sural muscle of the affected leg and a biphasic current with a symmetrical waveform at 50 Hz for 15 seconds, tuned for a 3-second ramp up time and a 30-second rest time with a 250-microsecond pulse duration was given with PNF stretching. Subjects in group 2 received the PNF stretching technique alone. Both group 1 and group 2 received these treatments for 4 weeks (4 days/week); follow-up assessments were administered in the third and fifth weeks. CG received no treatment; outcome measures alone were assessed. Outcome measures comprised pain, balance, flexibility, proprioception, range of motion, muscle strength, and functional limitation. A mixed-model ANOVA showed significant interaction (time and group) and the time effect for all the outcome measures (p ≤ 0.05). Group 1 (PNF-TENS) showed significant improvement for all the outcome variables compared to the other groups. The present study showed PNF stretching combined with TENS for the triceps sural muscle to trigger muscle contraction during the muscle contraction phase of the PNF stretch, compared against PNF stretching alone, produced significant improvements in ankle function for post ankle sprain subjects.

Surface Electrical Stimulation for Persistent Stuttering and Concomitant Orofacial Disorders: A Multiple Case Study.

This multiple case study analysis describes the immediate effects on speech fluency of transcutaneous electrical nerve stimulation (TENS) applied to participants with persistent stuttering and concomitant orofacial disorders. Study participants were 14 adolescents and adults who stuttered and had jaw clenching bruxism or mouth breathing. Participants experienced low-frequency TENS applied at mild motor level for 20 minutes with electrodes placed at the lower third of the face (Area A), submandibular region (Area B), posterior neck (Area C), or shoulder girdle (Area D), with speech fluency assessed immediately before and after each stimulation.For participants with stuttering and bruxism, AB stimulation reduced the median frequency of syllables stuttered by 27% and reduced the median duration of the three highest stuttering moments by 29%. In addition, for participants with stuttering and mouth breathing, CD stimulation reduced the median duration of the three highest stuttering moments by 28% and increased their median speech rate by 113%. As a single session of TENS may help participants with stuttering and concomitant orofacial disorders better use fluency shaping techniques, the therapeutic potential of TENS for treating stuttering should be further investigated.

Sensory Sub- and Suprathreshold TENS Exhibit No Immediate Effect on Postural Steadiness in Older Adults with No Balance Impairments.

Transcutaneous electrical nerve stimulation (TENS) has been reported to attenuate postural sway; however, the results are inconclusive, with some indicating the effect and others not. The study aimed to evaluate the effect of sensory sub- and suprathreshold low-frequency TENS applied through the plantar surface and posterior aspect of shanks on postural sway. In a group of healthy community-dwelling older adults, TENS was delivered with two different current intensities: (1) subsensory which is below conscious perception and (2) suprasensory threshold which is within the range of conscious perception. Frequencies of the TENS stimulation were sweeping from 5 to 180 Hz and were delivered through the plantar surface and posterior shanks of both legs. Postural sway was measured with a force platform in eyes-open and eyes-closed conditions. To evaluate potential fast adaptability to TENS stimuli, the results were evaluated in two time intervals: 30 seconds and 60 seconds. The results indicated that TENS with the chosen frequencies and electrode placement did not affect postural sway in both the sub- and suprathreshold intensities of TENS, in eyes-open and eyes-closed conditions, and in 30-second and 60-second time intervals. In conclusion, given that in this study sub- and suprathreshold TENS applied via the plantar surface of the feet did not attenuate postural sway, it would be easy to conclude that this type of electrical stimuli is ineffective and no further research is required. We must caution against this, given the specificity of the electrode placements. We recommend that future research be performed consisting of individuals with balance impairments and with different positions of electrodes.