Transcutaneous Electrical Nerve Stimulation Parameters Research Articles

Effects of transcutaneous electrical nerve stimulation on evoked tactile sensation for fingertip force control

BackgroundThe bidirectional communication between the hand and brain is profoundly reliant on tactile perception. Transcutaneous electrical nerve stimulation (TENS) can evoke tactile sensation, but its role in fingertip force control is not well understood. PurposeWe examined the tactile sensation evoked by TENS, especially the effects of concurrent modulation of TENS parameters compared to individual-parameter modulation on fingertip force control in both continuous (with dynamic stimulation force) and discrete (with static stimulation force) paradigms. MethodsCo-modulation was accomplished by linearly alteringTENS pulse width and frequency in fixed proportions either positively (both pulse width and frequency increased and decreased simultaneously) or negatively (one increased while the other decreased) at a given “stimulation” force level applied by an instructor. Subjects then generated a “response” force with their fingertips to demonstrate the strength of perceived tactile sensation. The mean, maximum, and duration of response forces and the ratios of response force to stimulation force were examined in different phases and consecutive trials of stimulation. ResultsThe positive and negative co-modulations led to stronger and longer duration response sensitivity than the individual modulations. In addition, subjects could effectively discriminate the evoked tactile sensation variations with co-modulated stimulation parameters from the lower to the higher modulation intensities. The co-modulations were more likely to cause sensory adaptations than the independent modulations. ConclusionThe findings of this study suggested that the co-modulated TENS can result in effective responses to tactile sensation when stimulation trials are controlled. The TENS with co-modulation may serve as an effective tool for eliciting tactile sensations for precise fingertip force control. The findings of this study may play a role in developing bidirectional hand/digit prostheses or restoring hand sensorimotor function.

Exploring the Rules of Related Parameters in Transcutaneous Electrical Nerve Stimulation for Cancer Pain Based on Data Mining.

This study aims to investigate the regularity of related parameters in the treatment of cancer pain using transcutaneous electrical nerve stimulation (TENS). A comprehensive literature search was conducted in databases such as PubMed, Cochrane Library, Embase, Web of Science, OVID, CNKI, CBM, VIP, and WANNGFANG from inception up to December 2022. A database was established, and data mining techniques were applied to analyze the relevant TENS parameters. A total of 27 articles were included, encompassing nine current frequencies, four retention times, four treatment frequencies, and two wave types. On the basis of the analysis of parameter association rules, the most closely related parameter combination for clinical TENS in the treatment of cancer pain was a current frequency of 2/100Hz, a treatment frequency of once a day, a retention time of 30min, and the dilatational wave. Moreover, the study involved 22 acupuncture points distributed along 13 meridians. According to the analysis of acupuncture point association rules, Hegu (LI04), Zusanli (ST36), and Sanyinjiao (SP06) were the most closely related acupuncture points and could be used in combination for clinical TENS in cancer pain treatment. Furthermore, cluster analysis was conducted on acupuncture points with a frequency ≥ 5, resulting in three categories: the first category included Sanyinjiao (SP06), Zusanli (ST36), Hegu (LI04), Jiaji point, and Neiguan (PC06); the second category included Ashi point; and the third category included Back shu point. In the treatment of cancer pain using TENS, it is recommended to use a current frequency of 2/100Hz, a treatment frequency of once a day, a retention time of 30min, and the dilatational wave. The electrode positions were primarily selected from Ashi point, Back shu point, Sanyinjiao (SP06), Zusanli (ST36), Hegu (LI04), Jiaji point, and Neiguan (PC06) to achieve the best analgesic effect.

Diferenças de sexo e idade no limiar sensitivo para estimulação elétrica transcutânea

Abstract Introduction Pain is one of the main symptoms prevalent in most pathologies. Transcutaneous Electrical Nerve Stimulation (TENS) represents not only a therapeutic measure, but also a mean to quantify the neurosensory and pain perception in patients with chronic pain. Objective To evaluate the relationship between sex and age with neurosensory thresholds (sensory threshold and tolerance threshold) in the application of therapeutic current in patients with chronic pain. Methods Forty-five patients with chronic pain (30 women and 15 men) aged between 24 and 87 years were selected. Each patient answered the Individual Questionnaire, McGill Pain Questionnaire (MPQ) and Beck Depression Inventory (BDI). Subsequently, the electric current was applied, through which the sensory and pain thresholds were analyzed, as well as the perception of activation of the neurosensory pathways for each individual. Data were analyzed using the SPSS 24.0 for Windows. Results There was no significant correlation (p > 0.05) between a possible depressive diagnosis and the perception of current by the sensory and pain thresholds. Regarding sex, there was a significant difference in sensory thresholds (p = 0.003) between men and women, while no statistical differences were observed between sexes for pain complaint and pain threshold (p > 0.05). For the correlational analysis, a significant correlation (p = 0.05) was identified between the variables BMI and pain tolerance threshold (r = 0.68) for females and age and sensory threshold (r = 0.65) for males. Conclusion The sex and age variables are important in the measurement of TENS parameters because they lead to significant differences in sensory and pain thresholds.

Transcutaneous Electrical Nerve Stimulation (TENS) for Primary Dysmenorrhea: An Overview.

Primary dysmenorrhea is a chronic health condition that affects primarily young women. Transcutaneous electrical nerve stimulation (TENS) has been suggested as an effective pain reduction modality in primary dysmenorrhea. TENS is a noninvasive, inexpensive, portable method with minimal risks and a few contraindications. When necessary, it can be self-administered on a daily basis during everyday activities. Several studies have investigated the effectiveness of TENS in reducing pain, decreasing the use of analgesics, and improving the quality of life in primary dysmenorrhea patients. These studies have some limitations in methodological quality and therapeutic validation. However, the overall positive effects of TENS in primary dysmenorrhea encountered in all prior studies indicated its potential value. This review presents the clinical recommendations for TENS parameters for treating primary dysmenorrhea symptoms based on previously published studies.

The Influence of Transcutaneous Electrical Nerve Stimulation Parameters on the Level of Pain Perceived by Participants With Painful Diabetic Neuropathy: A Crossover Study

Abstract Aims This pilot study aimed to investigate and compare the perceived pain relief effectiveness of two different modes of TENS in people with painful diabetic neuropathy (PDN). Methods A cross-over study was conducted at Charles Sturt University, Orange. Five participants with PDN were assessed with a McGill Pain Questionnaire before and after each of the two TENS treatments. Participants were randomly allocated to Traditional TENS (80 Hz, 200 ms) or Acupuncture-like TENS (2 Hz, 200 ms) and the treatments were applied daily for 30 min over ten days. Following a seven day washout period, the alternate mode of TENS was carried out using the same method. Wilcoxon Signed Rank tests were used to statistically analyse the results. Results All five participants reported personally meaningful pain relief during one or both of the TENS treatments. The Wilcoxon signed rank testing showed no statistical significance, p = 1, likely due to the small sample size. Acupuncture-like TENS had a large effect size (z = −1.625, r = 0.514), whilst Traditional TENS produced a medium effect size (z = −1.214, r = 0.384). No adverse effects were reported. Conclusion Acupuncture-like TENS may be more effective for PDN than traditional TENS. A larger scale replication of this pilot study is warranted.

A Comparative Study between Transcutaneous Electrical Nerve Stimulation and Fentanyl to Relieve Shoulder Pain during Laparoscopic Gynecologic Surgery under Spinal Anesthesia: A Randomized Clinical Trail.

Background Traditionally, laparoscopic procedures have been performed under general anesthesia. Spinal anesthesia is an effective alternative to general anesthesia. However, one of the intraoperative complications of performing laparoscopic surgery under spinal anesthesia is shoulder pain. This study aimed to compare the effect of transcutaneous electrical nerve stimulation (TENS) with fentanyl on pain relief in patients who underwent gynecologic laparoscopy under spinal anesthesia. Methods We conducted a prospective randomized clinical trial from May 2016 to March 2017. A sample of patients who underwent gynecological laparoscopy under spinal anesthesia was recruited. If they had shoulder pain, they randomly received either transcutaneous electrical nerve stimulation (TENS) or 50 mg of fentanyl. Pain intensity was measured using the single item visual analogue scale (VAS-10 cm) immediately before and 5, 10, 20, and 30 minutes after treatment. Also, the effect of higher doses of analgesia on pain relief was analyzed. Results In all, 80 patients (40 patients in each group) were entered into the study. The mean pain intensity score was 9.02 ± 1.32 in the TENS group and 8.95 ± 1.33 in the fentanyl group at baseline (P = 0.80). Repeated measures analysis of variance indicated that there was no significant difference on overall pain scores between the two treatment groups adjusted for age, BMI, total analgesia used, and baseline pain score (F (1, 74) = 1.44, P = 0.23). The use of analgesic drugs in the TENS group was significantly higher than the fentanyl group (P = 0.01). In addition, we found that nine patients (22.5%) complained of nausea/vomiting in the TENS group compared to thirteen patients (32.5%) in the fentanyl group (P = 0.31). Conclusions The findings indicated that TENS was not superior to fentanyl for pain relief in laparoscopic surgery. It seems that the correct use of TENS parameters might merit further investigation. This trial is registered with: IRCT2016031216765N3.

The influence of transcutaneous electrical nerve stimulation parameters on the level of pain perceived by participants with painful diabetic neuropathy: A crossover study

AimsThis pilot study aimed to investigate and compare the perceived pain relief effectiveness of two different modes of TENS in people with painful diabetic neuropathy (PDN). MethodsA cross-over study was conducted at Charles Sturt University, Orange. Five participants with PDN were assessed with a McGill Pain Questionnaire before and after each of the two TENS treatments. Participants were randomly allocated to Traditional TENS (80Hz, 200ms) or Acupuncture-like TENS (2Hz, 200ms) and the treatments were applied daily for 30min over ten days. Following a seven day washout period, the alternate mode of TENS was carried out using the same method. Wilcoxon Signed Rank tests were used to statistically analyse the results. ResultsAll five participants reported personally meaningful pain relief during one or both of the TENS treatments. The Wilcoxon signed rank testing showed no statistical significance, p=1, likely due to the small sample size. Acupuncture-like TENS had a large effect size (z=−1.625, r=0.514), whilst Traditional TENS produced a medium effect size (z=−1.214, r=0.384). No adverse effects were reported. ConclusionAcupuncture-like TENS may be more effective for PDN than traditional TENS. A larger scale replication of this pilot study is warranted.

An Investigation of the Effects of Different Pulse Patterns of Transcutaneous Electrical Nerve Stimulation (TENS) on Perceptual Embodiment of a Rubber Hand in Healthy Human Participants With Intact Limbs.

The aim of this study was to investigate the strength of perceptual embodiment achieved during an adapted version of the rubber hand illusion (RHI) in response to a series of modified transcutaneous electrical nerve stimulation (TENS) pulse patterns with dynamic temporal and spatial characteristics which are more akin to the mechanical brush stroke in the original RHI. A repeated-measures counterbalanced experimental study was conducted where each participant was exposed to four TENS interventions: continuous pattern TENS; burst pattern TENS (fixed frequency of 2 bursts per second of 100 pulses per second); amplitude-modulated pattern TENS (intensity increasing from zero to a preset level, then back to zero again in a cyclical fashion); and sham (no current) TENS. Participants rated the intensity of the RHI using a three-item numerical rating scale (each item was ranked from 0 to 10). Friedman's analysis of ranks (one-factor repeated measure) was used to test the differences in perceptual embodiment between TENS innervations; alpha was set at p ≤ 0.05. There were statistically significant differences in the intensity of misattribution and perceptual embodiment between sham and active TENS interventions, but no significant differences between the three active TENS conditions (amplitude-modulated TENS, burst TENS, and continuous TENS). Amplitude-modulated and burst TENS produced significantly higher intensity scores for misattribution sensation and perceptual embodiment compared with sham (no current) TENS, whereas continuous TENS did not. The findings provide tentative, but not definitive, evidence that TENS parameters with dynamic spatial and temporal characteristics may produce more intense misattribution sensations and intense perceptual embodiment than parameters with static characteristics (e.g., continuous pulse patterns).

EMG activity of finger flexor muscles and grip force following low-dose transcutaneous electrical nerve stimulation in healthy adult subjects

Somatosensory stimulation modulates cortical and corticospinal excitability and consequently affects motor output. Therefore, low-amplitude transcutaneous electrical nerve stimulation (TENS) has the potential to elicit favorable motor responses. The purpose of the two presented pilot studies was to shed light on TENS parameters that are relevant for the enhancement of two desirable motor outcomes, namely, electromyographic (EMG) activity and contraction strength of the finger flexors and wrist muscles. In 5 and 10 healthy young adults (in Study I and Study II, respectively) TENS was delivered to the volar aspect of the forearm. We manipulated TENS frequency (150 Hz vs. 5 Hz), length of application (10, 20, and 60 min), and side of application (unilateral, right forearm vs. bilateral forearms). EMG amplitude and grip force were measured before (Pre), immediately after (Post), and following 15 min of no stimulation (Study I only). The results indicated that low-frequency bursts of TENS applied to the skin overlying the finger flexor muscles enhance the EMG activity of the finger flexors and grip force. The increase in EMG activity of the flexor muscles was observed after 20 min of stimulation, while grip force was increased only after 1 h. The effects of uni- and bilateral TENS were comparable. These observations allude to a modulatory effect of TENS on the tested motor responses; however, unequivocal conclusions of the findings are hampered by individual differences that affect motor outcomes, such as in level of attention.

Effects of different frequencies of conventional transcutaneous electrical nerve stimulation on pressure pain threshold and tolerance

Pulse frequency is one of the key determinants of analgesic outcomes by transcutaneous electrical nerve stimulation (TENS). However, optimal settings remain unclear. To compare the effects of different frequencies of TENS, on pressure pain threshold and tolerance. Currents with pulse duration of 110 μs, and pulse frequencies of 60 pps or 150 pps were applied on the volar aspects of the dominant forearms of 20 healthy volunteers, on two consecutive days, in a randomized order. Threshold and tolerance were measured at the beginning, after the 15th and 30th minutes of the applications, and 30 minutes after the applications. Pressure pain threshold and tolerance values were higher at the 150 pps frequency, at all measurement times (p< 0.05). However, no frequencyXtime interaction and time-dependent changes were found for the outcome measures (p> 0.05). These findings established that, at 150 pps conventional TENS, threshold and tolerance values were consistently higher. These results are presented to inform future research regarding optimal conventional TENS parameters and to provide support for clinical applications.

Role of transcutaneous electrical nerve stimulation in post-operative analgesia.

The use of transcutaneous electrical nerve stimulation (TENS) as non-pharmacological therapeutic modality is increasing. The types of TENS used clinically are conventional TENS, acupuncture TENS and intense TENS. Their working is believed to be based on gate control theory of pain and activation of endogenous opioids. TENS has been used in anaesthesia for treatment of post-operative analgesia, post-operative nausea vomiting and labour analgesia. Evidence to support analgesic efficacy of TENS is ambiguous. A systematic search of literature on PubMed and Cochrane Library from July 2012 to January 2014 identified a total of eight clinical trials investigating post-operative analgesic effects of TENS including a total of 442 patients. Most of the studies have demonstrated clinically significant reduction in pain intensity and supplemental analgesic requirement. However, these trials vary in TENS parameters used that is, duration, intensity, frequency of stimulation and location of electrodes. Further studies with adequate sample size and good methodological design are warranted to establish general recommendation for use of TENS for post-operative pain.

The effect of Transcutaneous Electrical Nerve Stimulation for Pain Relief on Patient of Rib Fracture

Background: Patients with multiple rib fracture face high rates of pulmonary complications. Effective pain relief instituted early in these cases would be of immense benefit. The aim therefore was to find out the immediate effect of TENS on pain relief in patients with rib fractures. Methods: This was one time observational design, convenient sampling used, 7 consecutive patients with rib fracture were recruited from the Shree Krishna hospital, Karamsad. The patients were explained about Transcutaneous Electrical Nerve Stimulation (TENS) therapy & were given dual channel high TENS parameters for 30 minutes covering the site of pain. Before and immediately after TENS therapy, their Visual Analog Scale (VAS), Peak Expiratory Flow Rate (PEFR) & oxygen saturation (SpO2) were recorded & response was compared. Results: After data analysis the mean difference in VAS is from 6.43 to 3, which suggests that after application of TENS there is relief in pain by pain gate mechanism. There is markedly increase in PEFR from 90 to 121.43 (l/min). It reflects that patients breathing capacity is improved because of pain relief following TENS therapy. There is also increase in SpO2 level from 97.28% to 99%. Conclusions: It is concluded that TENS therapy is an effective, reliable and practical method in controlling pain and thereby improving pulmonary functions in the patients with rib fractures.

Dose-specific Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Experimental Pain

To determine the hypoalgesic effects of transcutaneous electrical nerve stimulation (TENS) parameter combinations on experimental models in healthy humans. Searches were performed using the electronic databases Ovid MEDLINE, CINAHL, AMED, and Web of Science (from inception to December 2009). Manual searches of journals and reference lists of retrieved trials were also performed. Randomized controlled trials (RCTs) were included in the review if they compared the hypoalgesic effect of TENS relative with placebo and control, using an experimental pain model in healthy human participants. Two reviewers independently selected the trials, assessed their methodologic quality and extracted data. Forty-three RCTs were eligible for inclusion. A best evidence synthesis revealed: Overall "conflicting" (inconsistent findings in multiple RCTs) evidence of TENS efficacy on experimental pain irrespective of TENS parameters used. Overall intense TENS has "moderate" evidence of efficacy (1 high-quality and 2 low-quality trials). Conventional TENS has overall conflicting evidence of efficacy, this is derived from "strong" evidence of efficacy (generally consistent findings in multiple high-quality RCTs) on pressure pain but strong evidence of inefficacy on other pain models. "Limited" evidence (positive findings from 1 RCT) of hypoalgesia exists for some novel parameters. Low-intensity, low-frequency, local TENS has strong evidence of inefficacy. Inappropriate TENS (using "barely perceptible" intensities) has moderate evidence of inefficacy. The level of hypoalgesic efficacy of TENS is clearly dependent on TENS parameter combination selection (defined in terms of intensity, frequency, and stimulation site) and experimental pain model. Future clinical RCTs may consider these TENS dose responses.

The effects of transcutaneous electrical nerve stimulation on spasticity

Transcutaneous electrical nerve stimulation (TENS) is commonly used in the treatment of chronic and acute pain with possible mechanisms of action including segmental inhibition, release of endogenous opioids, counter-irritation, nerve conduction block, and placebo. Although not frequently used in current practice, there is some evidence that TENS has an effect on spasticity in neurological conditions such as stroke, spinal cord injury, and multiple sclerosis. This paper reviews the results of studies undertaken to date, evaluating not only the effects of TENS on spasticity, but also the impact of different TENS parameters on its overall effectiveness. Recommendations based on the current evidence for the use of TENS in the treatment of spasticity are made, as well as suggestions for further study.

Evidence for Transcutaneous Electrical Nerve Stimulation in the Management of Low Back Pain?

Low back pain is a huge burden on society and the health care system, and cost the UK over £1.5 billion in 1998 alone. One of the modalities available to treat this condition is transcutaneous electrical nerve stimulation (TENS), a form of electrotherapy that is inexpensive and widely used by clinicians and patients alike for many conditions including pain relief. The aim of this review was to determine whether TENS is an effective treatment for pain relief in people with low back pain. This paper outlines the evidence for the use of TENS for low back pain, and recommends that future research should try to map specific TENS parameters with each of the different types of low back pain.

Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects

Transcutaneous electrical nerve stimulation (TENS) is a popular form of electrostimulation. Despite an extensive research base, there remains no consensus regarding the parameter selection required to achieve maximal hypoalgesic effects. The aim of this double blind, sham-controlled study was to investigate the relative hypoalgesic effects of different TENS parameters (frequency, intensity and stimulation site) upon experimentally induced mechanical pain. Two hundred and forty participants were recruited in order to provide statistical analysis with 80% power at α=0.05. Subjects were randomised to one of the six TENS groups, a control, and a sham TENS group ( n=30, 15 males, 15 females, per group). TENS groups differed in their combinations of stimulation; frequency (4 or 110 Hz), intensity (‘to tolerance’ or ‘strong but comfortable’) and stimulation site (segmental – over the distribution of the radial nerve or, extrasegmental – over acupuncture point ‘gall bladder 34’, or a combination of both segmental and extrasegmental). Pulse duration was fixed at 200 μs. Stimulation was delivered for 30 min and subjects were then monitored for a further 30 min. Mechanical pain threshold (MPT) was measured using a pressure algometer and taken from the first dorsal interosseous muscle of the dominant hand, ipsilateral to the stimulation site. MPT measures were taken, at baseline, and at 10-min intervals for 60 min. Difference scores were analysed using repeated measures and one-way ANOVA and relevant post hoc tests. Low frequency, high intensity, extrasegmental stimulation produced a rapid onset hypoalgesic effect, which increased during the stimulation period ( P<0.0005 control and sham) and was sustained for 30 min post-stimulation ( P<0.0005 control, P=0.024 sham). Whilst high frequency, ‘strong but comfortable’ intensity, segmental stimulation produced comparable hypoalgesic levels during stimulation, this effect was not sustained post-stimulation. Stimulation at a combination of the two sites did not produce any greater hypoalgesic effects. These results may have implications for the clinical use of sensory stimulation.

Transcutaneous electrical nerve stimulation: Effect on peripheral nerve conduction, mechanical pain threshold, and tactile threshold in humans

Objectives: To investigate the effect of different transcutaneous electrical nerve stimulation (TENS) parameters on nerve conduction in the human superficial radial nerve and on peripheral mechanical pain threshold (MPT) and tactile threshold (TT), and to further the current knowledge of the neurophysiologic effects of TENS. Study Design: Fifty healthy human subjects were randomly allocated in equal numbers to a control group or one of four TENS groups to receive electrical stimulation consisting of four combinations of TENS pulse durations (50μsec and 200μsec) and frequencies (4Hz and 110Hz). In the TENS groups, TENS was applied under double-blind conditions for 15 minutes over the superficial radial nerve in the dominant forearm. Over a 1-hour period, compound action potentials, MPT readings, and TT readings were recorded bilaterally. Results: Only one combination of TENS parameters (110Hz, 200μsec) effected consistent changes in all of the variables assessed, ie, TENS produced a significant increase in negative peak latency while simultaneously increasing both MPT and TT. Conclusion: The findings from this study suggest that at least part of TENS-mediated hypoalgesia is a consequence of a direct peripheral effect of TENS, although a “central” effect may not be excluded.

TENS: a treatment option for bladder dysfunction.

To ascertain the mode of action and benefits of transcutaneous electrical nerve stimulation (TENS) in detrusor overactivity, stress incontinence and interstitial cystitis, an English-language literature search using Medline (1984-1995) was undertaken with detrusor instability, incontinence, interstitial cystitis, neuromodulation, transcutaneous electrical nerve stimulation and urodynamics as keywords and the material so identified was reviewed. The mode of action of TENS and optimal stimulation parameters in bladder dysfunction remain unclear. Lack of strict selection criteria and deficient reporting of subjective and objective outcomes precluded full assessment of therapeutic efficacy. A beneficial effect was evident in some studies of detrusor overactivity and interstitial cystitis. A trial of TENS in detrusor overactivity and interstitial cystitis refractory to conventional therapy would seem justified. Continued experimental research and further clinical studies will lead to refinement of the treatment modality.

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION

Although Transcutaneous Electrical Nerve Stimulation (TENS) has become a popular modality in pain management over the past 20 yr, there is still debate over its mechanisms of action and the precise relevance of stimulation parameters to its hypoalgesic effects. Thus, confusion still surrounds the selection of optimal stimulation parameters. Two separate studies (total n = 88) were carried out to investigate the effect of four combinations of TENS pulse durations (50 microseconds & 200 microseconds) and frequencies (4 Hz and 110 Hz) on nerve conduction in the human superficial radial nerve and on Mechanical Pain Threshold (MPT) within the associated sensory distribution of the nerve over the dorsum of the hand. Results showed that application of one combination of TENS parameters (110 Hz, 200 microseconds) directly over the course of the nerve produced a significant increase in both peripheral nerve conduction latency (P < or = 0.05; analysis of variance (ANOVA)) and MPT (P < or = 0.01). In addition, there was a high correlation (r = 0.9) between shifts in MPT and negative peak latency for the groups treated with this combination of TENS parameters. The results of this study thus illustrate that combinations of TENS parameters are important to the peripheral neurophysiological effects of this modality and, further, its associated hypoalgesic effects, at least on the model of pain used here.