Electrical Nerve Stimulation Research Articles

Application of Electrical Stimulation in BCI in Patients with Alzheimer’s Disease

This paper systematically discusses the application prospect of neuromodulation technology in the treatment of Alzheimer’s disease (AD). It focuses on the potential role of various techniques, including transcutaneous electrical nerve stimulation (TENS), deep brain stimulation (DBS), repeated transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), in improving the cognitive function of AD patients. With the aggravation of the global aging problem, the incidence of AD is increasing year by year, and the existing treatment methods are difficult to effectively prevent the progress of the disease. Studies have shown that technologies such as TENS and DBS can improve patients’ memory and cognitive function to some extent. For example, a study by Smith et al. (2020) found that DBS applied to the fornix resulted in a 20% improvement in memory scores over a 6-month period. However, due to the small sample size and inconsistent experimental design, the universality and reliability of the existing research results are still limited. Future studies should aim for larger, more diverse sample sizes and standardized experimental protocols to enhance the robustness of findings. This article reviews the latest research results of these neuromodulation techniques, emphasizing the importance of optimizing treatment parameters and expanding the scale of clinical trials. The paper is structured as follows: first, this paper discusses each neuromodulation technique in detail; then, this paper analyzes their potential benefits and limitations; finally, this paper provides recommendations for future research directions.

Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial.

Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date. This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS. The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan. A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference -0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference -0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05). The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients' physical functions and spinal flexibility.

Effects of Cervical Mobilization on Balance and Proprioception in Patients With Nonspecific Neck Pain

ObjectiveThis study investigates the effect of cervical mobilization on balance and cervical proprioception in patients with nonspecific neck pain. MethodsA prospective, double-blind, randomized clinical trial was conducted involving a 3-week treatment protocol for which 66 patients were randomly assigned to 2 groups. Both groups underwent conventional physiotherapy (hot pack and transcutaneous electrical nerve stimulation) twice a week for 3 weeks along with additional cervical mobilization in the mobilization group, and sham mobilization in the sham control group. Static and dynamic balance, cervical proprioception, cervical mobility, and pain intensity were evaluated using a Kinesthetic Skill Training System 3000 device, the “Joint Position Error Test,” Cervical Range-of-Motion Instrument, and the visual analog scale, respectively. ResultsAfter treatment, significant improvements were noted in dynamic balance, mobility, pain intensity (P < .001, P < .001, P < .001, respectively), and proprioception in the left direction of rotation in the mobilization group (P = .003) that were significantly greater than those observed in the sham mobilization group (P < .001, P < .001, P < .001, P = .003, respectively). Although a significant decrease was observed in the deficits of static balance (P = .044) and proprioception in the right direction of rotation (P = .011) after mobilization, the changes were similar in both the mobilization and sham mobilization groups (P = .192, P = .154, respectively). ConclusionCervical mobilization led to significant improvements in dynamic balance, pain intensity, mobility, and partial improvements to proprioception in a comparison with a sham mobilization group, while the effect on static balance was not significant.

Comparative efficacy of non-pharmacological interventions on xerostomia and salivary flow rate among hemodialysis patients: a systematic review and network meta-analysis

Abstract Background Xerostomia is a distressing symptom experienced by patients undergoing dialysis. We sought to compare and rank the efficacy of different non-pharmacological interventions on xerostomia and salivary flow rate among dialysis patients. Methods A systematic search was conducted in six English databases: Pubmed, CINAHL, Scopus, Web of Science, Embase, and Cochrane trials, in April 2023. Screening, quality appraisal, and data extraction were undertaken by two independent reviewers. A network meta-analysis was performed to assess the relative efficacy of different non-pharmacological interventions. Results The analysis included 11 randomized controlled trials involving 739 patients and eight non-pharmacological interventions. The pairwise analysis indicated that in comparison with the control group, sugarless candy, chewing sugarless gum, acupressure auricular, and licorice mouthwash had a significant positive effect on reducing the severity of xerostomia, also transcutaneous electrical nerve stimulation (TENS), licorice mouthwash, sugarless chewing gum, photobiomodulation, and pure water mouthwash, significantly improved saliva flow rate. The network analysis indicated that sugarless chewing gum significantly reduced the symptoms of xerostomia, while TENS and sugarless chewing gum were effective in improving UWS. Chewing sugarless gum and using TENS were the top-ranked interventions for relieving xerostomia and enhancing saliva flow rate among dialysis patients, respectively. Conclusions Several non-pharmacological interventions have demonstrated effectiveness in relieving xerostomia and enhancing saliva flow rates. While further research may be needed to confirm and refine these findings the interventions used in this review offer promising results and should be incorporated into the standard care of dialysis patients experiencing these symptoms to enhance their quality of life and oral health.

Acute Traumatic Coma Awakening Induced by Median Nerve Electrical Stimulation: A Systematic Review and Meta-Analysis.

Traumatic brain injury (TBI) is widely recognized as a major cause of death and disability. Optimizing recovery from coma is a priority for improving patient prognosis. Recently, an increasing number of studies have demonstrated that median nerve electrical stimulation (MNES) may be a potential approach for comatose patients awakening with TBI, although the results of these studies are not consistent. The aim of this study was to evaluate the effects of the MNES on recovery from coma in patients with TBI based on data from randomized controlled trials. The PubMed, Embase, Ovid MEDLINE, Cochrane Library, and China National Knowledge Infrastructure electronic databases were systematically searched from their inception to July 2023 using specific keywords. The χ2 test and I2 test were used to evaluate the heterogeneity across these studies. The mean differences with 95% confidence intervals (CIs) and relative risk (RR) with 95% CIs were adopted to analyze the continuous outcomes and binary outcomes, respectively. A total of 1831 patients from 18 studies were included in this meta-analysis. There were significant differences in the proportions of patients who regained consciousness between the MNES group and the control group after treatment (RR 1.36, 95% CI 1.18-1.56; P < 0.001) and at 6 months after injury (RR 1.31, 95% CI 1.16-1.47; P < 0.001). MNES significantly improved the Glasgow Coma Scale score (mean difference 2.38, 95% CI 1.78-2.98; P < 0.001). Furthermore, no significant differences in complications between the two groups of patients were observed, including pneumonitis (RR 0.86, 95% CI 0.72-1.03; P = 0.107), seizures (RR 1.24, 95% CI 0.49-3.10; P = 0.651), or gastric hemorrhage (RR 1.08, 95% CI 0.60-1.93; P = 0.795).The results of the present study indicate that patients with TBI in the MNES group recovered from coma more rapidly after treatment and at 6months after injury. These results suggest that MNES is an effective approach for coma awakening after TBI.

Beyond Painkillers: A Meta-Analysis of Non-Pharmacological Approaches for Managing Dysmenorrhea Symptoms

Dysmenorrhea, commonly known as painful menstruation, is a highly prevalent gynecological condition affecting millions of women globally. While pharmacological interventions offer temporary relief, they often come with undesirable side effects. Non-pharmacological approaches present a potentially safer and more sustainable alternative for managing dysmenorrhea symptoms. A comprehensive search of electronic databases, including PubMed, Scopus, and Web of Science, was conducted to identify randomized controlled trials (RCTs) published between 2014 and 2024 that investigated the effectiveness of non-pharmacological interventions for dysmenorrhea. The primary outcome was pain intensity reduction, while secondary outcomes included quality of life, absenteeism, and medication use. Data were pooled using a random-effects model, and standardized mean differences (SMDs) were calculated. Six RCTs met the inclusion criteria, encompassing a total of 600 participants. The non-pharmacological interventions evaluated included aerobic exercise, yoga, acupuncture, transcutaneous electrical nerve stimulation (TENS), heat therapy, and relaxation techniques. The pooled analysis revealed significant reductions in pain intensity across all interventions compared to control groups (SMD = -2.00, 95% CI: -2.39 to -1.61, p &lt; 0.001). Aerobic exercise and yoga demonstrated the largest effect sizes (SMD = -2.5 and -2.5, respectively). Significant improvements were also observed in quality of life, absenteeism, and medication use. Non-pharmacological approaches, particularly aerobic exercise and yoga, are effective in managing dysmenorrhea symptoms. These findings strongly support the integration of non-pharmacological interventions into clinical practice as a first-line or adjunctive treatment option for dysmenorrhea.

Low-value interventions to deimplement: A secondary analysis of a systematic review of low back pain clinical practice guidelines.

To perform a secondary review of low back pain (LBP) clinical practice guidelines (CPG) identified in a recently conducted systematic review and to synthesize and summarize low-value recommendations as practices that may be candidates for deimplementation. LBP (subacute or chronic) CPGs in English (symptom based, created by a governmental or professional society, published between January 1990 and May 2020) were previously identified using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, Emergency Care Research Institute, Guidelines International Network, National Institute of Health and Care Excellence, and Scottish Intercollegiate Guideline Network. Twenty-one CPGs were reviewed from a systematic review (previously published). Full-text review of all 21 CPGs was conducted, and three recommendation categories indicative of low value (recommend strongly against, recommend weakly against, inconclusive/insufficient evidence) were identified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) language and approach. One hundred thirty-five low-value recommendations were identified and classified under eight intervention categories: orthotics/support, traction, physical modalities, pharmacological interventions, injections, surgery, bed rest, and miscellaneous. Traction, transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (TUS), and selective serotonin reuptake inhibitors (SSRI) had the most CPGs recommend strongly against their usage. Opioids were recommended strongly against by four CPGs. No significant difference (p > .05) was found between CPG quality and a specific deimplementation recommendation or between CPG quality and the number of strongly against, weakly against, and inconclusive/insufficient evidence recommendations. Clinicians managing patients with chronic LBP should consider deimplementing these low-value interventions (traction, TENS, TUS, and SSRI).

Management of menstrual and endometriosis-associated pain from a physiotherapy perspective

Both menstrual pain and endometriosis affect a significant number of individuals worldwide. Although medication and surgery are often recommended paths of treatment, approximately 40% of people still suffer from ongoing problems, especially persistent pain. A growing body of literature suggests that physiotherapy may have a significant role to play in treatment; for example, transcutaneous electrical nerve stimulation for non-invasive pain relief, exercise prescription and addressing the effects of central sensitization. This clinical commentary reviews the issues faced by those dealing with both dysmenorrhea and endometriosis. It also reviews the literature on the current and potential roles of physiotherapy in improving quality of life via a low-risk, low-cost, but very effective, array of interventions within our scope of practice.

Ultrasound guided transcutaneous phrenic nerve stimulation in critically ill patients: a new method to evaluate diaphragmatic function.

Diaphragm dysfunction is common in intensive care unit and associated with weaning failure and mortality. Diagnosis gold standard is the transdiaphragmatic or tracheal pressure induced by magnetic phrenic nerve stimulation. However, the equipment is not commonly available and requires specific technical skills. We aimed to evaluate ultrasound guided transcutaneous phrenic nerve stimulation for daily bedside assessment of diaphragm function by targeted electrical phrenic nerve stimulation. In this randomized cross-over study we compared a new method of ultrasound guided transcutaneous electrical phrenic nerve stimulation (SONOTEPS method) using a peripheral nerve stimulator, with the magnetic phrenic nerve stimulation. Intensive care unit adult patients under mechanical ventilation with a Richmond-Agitation-Sedation-Scale score of -4 or -5 were included. Each patient received the two methods of stimulation, in a randomized order. The primary outcome was the tracheal pressure (Ptrach) induced by stimulation. We analyzed 232 measures of Ptrach from 116 patients of whom 77 presented a diaphragm dysfunction (Ptrach < 11 cmH2O) and 50 a severe diaphragm dysfunction (Ptrach < 8 cmH2O). The Passing-Bablok regression showed no significant differences (intercept A of -0.03 [CI95:-0.83-0.52] and slope B of 0.98 [CI95:0.90-1.05]) between SONOTEPS method and magnetic stimulation which were positively correlated (R²=0.639). The mean bias was -1.08 (CI95 5.02, -7.18) cmH2O. The receiver operating curves showed an excellent performance for the diagnosis of diaphragm dysfunction and severe diaphragm dysfunction with respectively an area under curve of 0.90 (CI95 0.83-0.97) and 0.88 (CI95 0.82-0.95). This performance was not significantly affected by the body mass index or the presence of a neck catheter. The SONOTEPS method is a simple and accurate tool for bedside assessment of diaphragm function with ultrasound guided transcutaneous phrenic nerve stimulation in sedated patients with no or minimal spontaneous respiratory activity.

Acute transcutaneous auricular vagus nerve stimulation modulates presynaptic SV2A density in healthy rat brain: An invivo microPET study.

Vagus nerve stimulation (VNS) is the subject of exploration as an adjunct treatment for neurological disorders such as epilepsy, chronic migraine, pain, and depression. A non-invasive form of VNS is transcutaneous auricular VNS (taVNS). Combining animal models and positron emission tomography (PET) may lead to a better understanding of the elusive mechanisms of taVNS. We evaluated the acute effect of electrical stimulation of the left vagus nerve via the ear on brain synaptic vesicle glycoprotein 2A (SV2A) as a measure of presynaptic density and glucose metabolism in naïve rats. Female Sprague-Dawley rats were imaged with [11C]UCB-J (n = 11) or [18F]fluorodeoxyglucose ([18F]FDG) PET (n = 13) on two separate days, (1) at baseline, and (2) after acute unilateral left taVNS or sham stimulation (30 min). We calculated the regional volume of distribution (VT) for [11C]UCB-J and standard uptake values (SUV) for [18F]FDG. We observed regional reductions of [11C]UCB-J binding in response to taVNS ranging from 36% to 59%. The changes in taVNS compared to baseline were significantly larger than those induced by sham stimulation. The differences were observed bilaterally in the frontal cortex, striatum, and midbrain. The [18F]FDG PET uptake remained unchanged following acute taVNS or sham stimulation compared to baseline values. This proof-of-concept study shows for the first time that acute taVNS for 30 min can modulate invivo synaptic SV2A density in cortical and subcortical regions of healthy rats. Preclinical disease models and PET ligands of different targets can be a powerful combination to assess the therapeutic potential of taVNS.

Niclosamide attenuates erectile dysfunction and corporal fibrosis via reversal of Smad signaling in diabetic rat model.

Diabetes mellitus-induced erectile dysfunction (DMED) is a common urological complication of diabetes, and current drugs often fail to provide an effective treatment. Smad2/3 signaling-mediated corporal fibrosis has a critical role in the molecular basis of DMED. We investigated the effect of Niclosamide (Nic), an antihelmintic drug with antifibrotic effects, on erectile function in a rat DMED model. Male Sprague Dawley rats were injected intraperitoneally (i.p) with streptozotocin (75mg/kg) to induce diabetes. At week 8, both diabetic and nondiabetic rats were treated with Nic (10mg·kg-1/day; i.p) or vehicle for 4weeks. At week 12, erectile function was evaluated as intracavernous pressure (ICP) response to the electrical stimulation of the cavernous nerve (CN). Penile tissues were harvested for Masson's trichrome staining or western blotting to determine corporal fibrosis and Smad2/3 pathway-related protein expression, respectively. At the end of the experimental protocol, in vivo erectile function was assessed by measuring the ratio of ICP/ mean arterial pressure (MAP) and total ICP following CN stimulation. Smooth muscle content and collagen fibers were evaluated by Masson's trichrome staining of the penile tissues. The expressions of fibrosis-related proteins (Smad2, Smad3, fibronectin) were determined using western blotting in the penile tissues. Erectile function, as determined by the maximum ICP/MAP and total ICP/MAP ratios, was drastically decreased in diabetic rats. Corporal tissues of diabetic rats were severely fibrotic with a significant increase in collagen fibers and a marked reduction in smooth muscle content. Also, the protein expressions of phosphorylated (p-)Smad2, p-Smad3 and fibronectin were significantly increased in the penis of diabetic rats. Both functional and molecular alterations in DMED were effectively reversed by Nic-treated diabetic rats without a glycemic alteration. Nic could be a promising candidate for the treatment of DMED due to its antifibrotic effects. The present study provides the first evidence that Nic has beneficial effect on erectile dysfunction by attenuating corporal fibrosis in a rat model of DMED. The effect of Nic on penile endothelial function and the other potential underlying mechanisms needs to be further elucidated. Nic improved erectile function in DMED rats possibly suppressing penile fibrosis by inhibiting Smad2/3 signaling. These results suggest a potential therapeutic repurposing of Nic as an adjuvant treatment in DMED.

Transcutaneous electrical nerve stimulation therapy in the management of temporomandibular joint disorders

A collection of illnesses known as temporomandibular joint disorders (TMD) impact the masticatory system, which includes the temporomandibular joint (TMJ) and the masticatory muscles, functionally. Transcutaneous electrical nerve stimulation (TENS) is one of several known aetiologies that have unique therapy options. A review of TENS use in TMD patient care is included in the current paper. Among the effective therapy modalities for treating TMD is transcutaneous electrical nerve stimulation. It involves carefully exposing the skin's surface to electrical current, which relaxes tense muscles and lessens discomfort.

Periodontitis accelerates the onset of hypertension in spontaneously hypertensive rats, while the electrical activation of the carotid sinus nerve delays the beginning of the increase in blood pressure.

We have previously demonstrated that electrical stimulation of the carotid sinus nerve (CSN) protects the development of periodontitis. In the current study, we evaluated whether periodontitis accelerates the onset of hypertension in spontaneously hypertensive rats (SHR); and whether electrical stimulation of the CSN would delay the onset of hypertension. Three-week old SHR were implanted with electrodes around the CSN for electrical stimulation for 13 days. Bilateral ligation of the first molar and oral administration of Porphyromonas gingivalis induced periodontitis. The femoral artery of the SHR was cannulated, and 24 h later, in a conscious state, the blood pressure was recorded. Five-week old sham SHR (subjects without electrical stimulation of the CSN) did not demonstrate hypertension. However, when the SHR were submitted to periodontitis they exhibited hypertension at 5 weeks of age. Nevertheless, the stimulation of the CSN prevented the onset of hypertension. Periodontitis promoted alveolar bone loss in SHR; but, electrical stimulation of the CSN prevented this undesirable outcome following the exposure to periodontitis. Periodontitis accelerated the onset of hypertension in SHR; while the electrical stimulation of the CSN delayed the onset of hypertension.

The Management of Children and Adolescents with Overactive Bladder Refractory to Treatment with Parasacral Transcutaneous Electrical Nerve Stimulation.

Although parasacral TENS (pTENS) has been employed in various centers, there is a lack of studies on how children with overactive bladder (OAB) respond after failing to complete pTENS sessions. This study aimed to describe and assess treatments for OAB in children who did not respond to pTENS. This retrospective case series examined patients aged 4-17 years. Patients were given subsequent treatment options, including: behavioral therapies; oxybutynin; imipramine; a combination of oxybutynin and imipramine; parasacral percutaneous electrical nerve stimulation (PENS); or a repeat course of pTENS. Outcomes were evaluated using the Dysfunctional Voiding Scoring System (DVSS) and the Visual Analogue Scale (VAS). Thirty children were included, with a median age of 7 years. Patients received one or more treatments. Of these, 70% underwent monotherapy. Among them, 57% experienced complete resolution of symptoms, 28% had partial resolution and were satisfied with the results, and 14% discontinued treatment. 30% out of the whole sample continued to experience bothersome symptoms. Complete response, according to initial subsequent, was achieved in: 54% with intensified behavioral therapies, 33% with oxybutynin, and 50% with imipramine alone. The median DVSS score decreased from 7.0 to 2.0 (p=0.025), while the median VAS score increased from 80 to 100 (p<0.001). Children with OAB refractory to pTENS who received structured subsequent treatments showed partial response in all cases, with complete symptom resolution in half of the patients. More intensive urotherapy, medications, or repeat pTENS in combination with oxybutinin can be effective for managing this challenging condition.

A comparative study of changes in Hmax/Mmax under spinning permanent magnet stimulation, repetitive peripheral magnetic stimulation, and transcutaneous electrical nerve stimulation in healthy individuals.

We have developed a compact device using a spinning permanent magnet (SPM) that induces an electrical field by changing the magnetic flux. We hypothesized that SPM stimulation also reduced spasticity, comparable with repetitive peripheral magnetic stimulation (rPMS) and transcutaneous electrical nerve stimulation (TENS). This study evaluated the effect of a single session of SPM stimulation and compared it with those of rPMS and TENS in healthy individuals. Eleven healthy adult men participated in this study. The active electrode was placed on the soleus muscle, and the reference electrode was placed at 5 cm distal from the active electrode on the medial side of the Achilles tendon. The stimulating electrodes were fixed on the popliteal fossa to stimulate the tibial nerve. The maximum H-reflex (Hmax) and the maximum motor response (Mmax) were measured, and Hmax/Mmax was calculated under the following conditions: a) 15 min SPM stimulation, b) 30 min SPM stimulation, c) 10,000 pulses rPMS, d) 15 min TENS, and e) 15 min rest (control). The devices for SPM, rPMS, and TENS were applied to the belly of the soleus muscle in the prone position. Compared with the control, Hmax/Mmax significantly decreased under SPM stimulation for 15 and 30 min, as well as under rPMS and TENS (p < 0.005). The changes in Hmax/Mmax under 15 min SPM stimulation were significantly smaller than those under 30 min SPM stimulation and rPMS (p < 0.005). SPM stimulation reduced Hmax/Mmax in healthy individuals and is a potential new treatment for spasticity.

Effect of Electrical Stimulation of Lingual Nerve on Xerostomia: A Randomized Controlled Trial.

Xerostomia is a subjective sensation of dry mouth affecting millions of people worldwide. Current management has limitations, often causing side effects. This study aims to investigate whether electrical stimulation of the lingual nerve could offer effective relief for xerostomia sufferers. Eligible participants were randomly assigned (1:1) to either the experimental or sham group, receiving electrical stimulation of the lingual nerve (n = 24) or sham stimulation (n = 23) for 12 wk. The primary outcome is the changes in xerostomia score using a 100-mm visual analog scale throughout the therapy. Participants assessed their dryness and assigned corresponding scores, with lower scores indicating more severe dry mouth. Secondary outcomes included remission rate in dry mouth frequency, changes in stimulated/unstimulated salivary flow rate (SSFR/USFR), and changes in Oral Health Impact Profile-14 (OHIP-14) questionnaire scores, where higher scores indicate greater impact on oral quality of life. At week 12, the electrical stimulation group showed greater improvement in xerostomia score compared to the sham group, with a mean between-group difference of 13.8 (95% confidence interval [CI], 10.0-17.6). The therapeutic effect of electrical stimulation was also confirmed by secondary outcomes. The remission rate of dry mouth was higher at 12 wk in the electrical stimulation group (61.9% [95% CI, 40.9%-79.3%] vs. 28.6% [95% CI, 13.8%-50.0%]). Participants in the electrical stimulation group also experienced a greater increase in USFR, with a mean difference of 14.5 (6.1-23.0) μL/min. Moreover, they exhibited significant improvement in OHIP-14 score after 12 wk of therapy, with a mean between-group difference of -10.0 (-13.9 to -6.2). No significant difference was observed between the 2 groups for SSFR (P = 0.702). Electric stimulation offers promise as a noninvasive, nonpharmacological strategy for the management of xerostomia. Further research is needed to understand its long-term effectiveness, optimal parameters, and underlying mechanisms. The study confirmed that electrical stimulation of the lingual nerve is a promising noninvasive and nonpharmacological modality for relief of xerostomia.

Exploring vagal neuromodulation: a novel approach to managing pain sensitivity in irritable bowel syndrome

Exploring vagal neuromodulation: a novel approach to managing pain sensitivity in irritable bowel syndrome Irritable bowel syndrome (IBS) is a common, chronic gastrointestinal disorder characterised by recurring abdominal pain and discomfort. This project will work under the hypothesis that IBS is linked to a malfunctioning of the brain-gut communication axis and proposes to address this dysfunction through transcutaneous electrical vagus nerve stimulation. To assist in identifying IBS patients suitable for this treatment, the study team aims to develop a neural signature using biometrics and neuroimaging. The study has the potential to revolutionise the treatment of IBS and other pain disorders, providing personalised and effective therapies.

8343 The Role Of Pancreatic Nerve Activity On The Development Of Beta Cell Dysfunction With The Macrophage-Beta Cell Interaction

Abstract Disclosure: J. Yu: None. Y. Wang: None. L. Sha: None. Islet inflammation is a vital factor to the beta cell dysfunction which is driven by inflammatory cytokines TNF-α and IL-1β released by resident macrophages. Pancreatic nerve innervates islet function and our previous study suggested that pancreatic nerve activity might involved in the development of pancreatic beta cell dysfunction. However, it is not known whether pancreatic nerve activity modulates macrophage activity and contributes to the macrophage - beta cell interaction. The aim of our study was to investigate the role of nerve activity on it and the possible mechanism. Methods: Sprague Dawley Rats and high fat diet-induced obese rates were used. An intrapancreatic nerve truck with its intact innervated pancreatic islets were used for the study. The nerve activity was evoked with electric nerve stimulation and insulin and ATP released by beta cells, TNF-α released by macrophages, and IL-1β released mainly by macrophages were measured with nerve activation. Results: Insulin secretion was induced significantly with the nerve activation (8 Hz). With nerve activation, ATP level was significantly increased by 25.5 ± 11.7%. The increased releases of insulin and ATP were abolished with cholinergic M receptor blocker atropine. With nerve activation, TNF-α and IL-1β levels were increased by 25.3±7.6% and 51.8±11.7%, respectively (p&amp;lt;0.05). Interestingly, the increases of TNF-α and IL-1β with nerve activation were also blocked by atropine. Since it is known that acetylcholine does not induce pro-inflammatory cytokine release in macrophages, we suspected that the nerve activity induced TNF-α and IL-1β releases were indirect. ATP is likely a candidate for the indirect effect as receptors. With applying Suramin, a ATP receptor blocker, nerve activation increased TNF-α release was inhibited significantly and IL-1β release was trended to inhibited. atropine, an M receptor blocker, compared with the Control group, decreased by 88.0±3.7% and 63.1±19.6%, respectively (p&amp;lt; 0.01). In obese rats, nerve activation increased TNF-α and IL-1β content by 68.1 ± 22.6% and 39.7 ± 7.4%, respectively, and suramin significantly inhibited the nerve activation induced increase of TNF-α release and trended to inhibit IL-1β release. Conclusion: Our results suggested that the pancreatic nerve activity contribute to the macrophage-beta cell interaction in the development of beta cells dysfunction by enhancing ATP release from islet beta cells. Presentation: 6/3/2024

Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) for Management of Pain Associated With Hysteroscopy: A Systematic Review

Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) for Management of Pain Associated With Hysteroscopy: A Systematic Review

Risk factors for poor prognosis in patients with zoster-associated neuralgia who underwent interventional pain management.

Zoster-associated neuralgia (ZAN) is recognized as a challenging neuralgia that often leads to poor prognosis in patients receiving interventional pain management. Identifying risk factors early can enable clinicians to develop personalized treatment plans; however, research in this area is limited. We retrospectively screened all patients with ZAN who received interventional therapy in the Pain Department of Soochow University First Affiliated Hospital from January 1, 2022 to August 31, 2023. Data on patient demographics, medical history, neutrophil-to-lymphocyte ratio (NLR), clinical scoring, and treatment methods were collected. Interventional therapy included short-term nerve electrical stimulation (st-NES), pulsed radiofrequency (PRF) and radiofrequency thermocoagulation (RF-TC). Patients were categorized into poor prognosis and control groups based on outcomes 3 months post-discharge. Multivariate logistic regression was used to identify risk factors for poor prognosis. The final analysis included 282 patients. The rate of poor prognosis was 32.6% (92/282). Multivariate logistic regression analysis revealed that age ≥ 65 years (odds ratio, 2.985; 95% confidence interval, 1.449-6.148; p = 0.003), disease duration >3 months (odds ratio, 3.135; 95% confidence interval, 1.685-5.832; p < 0.001), head and face pain (odds ratio, 3.140; 95% confidence interval, 1.557-6.330; p = 0.001), use of immunosuppressants (odds ratio, 2.737; 95% confidence interval, 1.168-6.416; p = 0.021), higher NLR (odds ratio, 1.454; 95% confidence interval, 1.233-1.715; p < 0.001), PRF (st-NES as reference) (odds ratio, 2.324; 95% confidence interval, 1.116-4.844; p = 0.024) and RF-TC (st-NES as reference) (odds ratio, 5.028; 95% confidence interval, 2.139-11.820; p < 0.001) were found to be independent risk factors for poor prognosis in patients with ZAN who underwent interventional pain management. Age ≥ 65 years (odds ratio, 2.985; 95% confidence interval, 1.449-6.148; p = 0.003), disease duration >3 months (odds ratio, 3.135; 95% confidence interval, 1.685-5.832; p < 0.001), head and face pain (odds ratio, 3.140; 95% confidence interval, 1.557-6.330; p = 0.001), immunosuppressants use (odds ratio, 2.737; 95% confidence interval, 1.168-6.416; p = 0.021), higher NLR (odds ratio, 1.454; 95% confidence interval, 1.233-1.715; p < 0.001), PRF (odds ratio, 2.324; 95% confidence interval, 1.116-4.844; p = 0.024) and RF-TC (odds ratio, 5.028; 95% confidence interval, 2.139-11.820; p < 0.001) were identified as independent risk factors for poor prognosis in patients with ZAN who underwent interventional pain management.