Transcutaneous Electrical Nerve Stimulation Unit Research Articles

A Study on Duration of Effect of Transcutaneous Electrical Nerve Stimulation Therapy on Whole Saliva Flow.

Saliva is a complex fluid, whose important role is to maintain the well being of oral cavity. Salivary gland hypofunction or hyposalivation is the condition of having reduced saliva production which leads to the subjective complaint of oral dryness termed xerostomia.(7) Management of xerostomia includes palliative therapy using topical agents or systemic therapy. Electrostimulation to produce saliva was studied in the past and showed moderate promise but never became part of mainstream therapy. Hence, this study was undertaken to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) on whole salivary flow rate in healthy adults and to evaluate how long this effect of TENS lasts on salivary flow. One hundred healthy adult subjects were divided into five age groups with each group containing 20 subjects equally divided into males and females in each group. Unstimulated saliva was collected using a graduated test tube fitted with funnel and quantity was measured. Transcutaneous electrical nerve stimulation unit was activated and stimulated saliva was collected. Saliva was again collected 30 minutes and 24 hours post stimulation. The mean unstimulated whole saliva flow rate for all subjects (n = 100) was 2.60 ml/5 min. During stimulation, it increased to 3.60 ± 0.39 ml/5 min. There was 38.46% increase in salivary flow. Ninety six out of 100 responded positively to TENS therapy. Salivary flow remained increased 30 minutes and 24 hours post stimulation with the values being 3.23 ± 0.41 ml/5 min and 2.69 ± 0.39 ml/5 min respectively. Repeated measures One way analysis of variance (ANOVA) test showed that the difference between these values were statistically significant. Transcutaneous electrical nerve stimulation therapy was effective for stimulation of whole saliva in normal, healthy subjects and its effect retained till 30 minutes and a little up to 24 hours. Transcutaneous electrical nerve stimulation may work best synergistically with other sialagogues and can be used for the management of xerostomia.

Evaluation of effect of transcutaneous electrical nerve stimulation on salivary flow rate in radiation induced xerostomia patients: a pilot study.

Xerostomia is a common sequel in patients undergoing irradiation of malignant tumors of the head and neck. Palliative treatments of xerostomia like topical agents such as ice-chips, saliva substitutes, systemic sialogogues like pilocarpine and cevimeline work well for some patients. Electrostimulation was studied in the past and showed moderate promise but never became part of the mainstream therapy for better management of xerostomia patients. The aim of the following study is to evaluate the effectiveness of a transcutaneous electrical nerve stimulation (TENS) unit in stimulating the whole salivary flow rate in radiation induced xerostomia patients. A total of 40 subjects were included in the study. The study group consisted of 30 individuals and was divided into Group S1 (n = 20), which was further subdivided into Group S1A (n = 10) subjects complaining of dry mouth who were undergoing head and neck radiotherapy with TENS stimulation during the commencement of radiotherapy, on the 3 rd , 6 th week and after a month of completion of radiotherapy and Group S1B (n = 10) with TENS stimulation daily during the full course of radiotherapy and Group S2 (n = 10) subjects complaining of dry mouth who had undergone head and neck radiotherapy that ended 1 month prior to their entry into the study. The control group (n = 10) consisted of healthy individuals not complaining of dry mouth and who have not undergone head and neck radiotherapy. Whole saliva was collected without stimulation for 10 min and after electrostimulation with TENS unit for additional 10 min in a graduated test tube. The results were statistically analyzed using Mann-Whitney U-test and Kruskal-Wallis's test. The data analysis revealed that control and S1B group showed increased salivary flow rate after stimulation by TENS therapy compared with the unstimulated salivary flow, whereas in S1A and S2 group it was found to be statistically non-significant. The present study gave us an insight about the effectiveness of TENS therapy in stimulating salivary flow in healthy subjects and it is very effective when used in conjunction with radiation therapy by reducing the side-effects of radiation therapy. Hence, TENS therapy can be used as an adjunctive method for the treatment of xerostomia along with other treatment modalities.

Electric Music (for Helen Keller)

The artist describes Electric Music (for Helen Keller), a performance of music for deaf audiences that uses four electrode pads of a Transcutaneous Electrical Nerve Stimulation unit to perform music directly on the body of the listener.

Prospective Phase II Study of the Efficacy of Transcutaneous Electrical Nerve Stimulation in Post-radiation Patients

AimsTo evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) delivered using an extra-oral device in patients with radiation-induced xerostomia. Materials and methodsThirty oral cavity and oropharyngeal cancer patients post-adjuvant (n = 26) or definitive radiotherapy (n = 4) were enrolled in this study. The TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated whole saliva was collected for 5 min into graduated tubes using the low forced spitting method. The TENS unit was then activated and stimulated saliva was collected for an additional 5 min. The difference between unstimulated and stimulated saliva output was measured using the paired t-test. Linear regression was used to determine factors significantly influencing the improvement in salivary output. ResultsTwenty-nine of 30 patients showed increased saliva flow during stimulation. A statistically significant improvement in saliva production (P < 0.05) during stimulation was noted. The mean unstimulated saliva flow was 0.056 ml/min and the mean stimulated saliva flow was 0.12 ml/min with a median increase of 0.06 ml/min. The interval to the application of TENS after radiotherapy significantly influenced the improvement in salivary flow. ConclusionExtra-oral application of TENS is effective in increasing the whole salivary flow in most of the post-radiated oral cavity/oropharyngeal cancer patients with xerostomia. TENS therapy may be useful as an effective supportive treatment modality in post-radiated oral cancer patients.

Evidence-Based Approach of Treatment Options for Postoperative Knee Pain

Optimal pain management is critical after knee surgery to avoid adverse events and to improve surgical outcomes. Pain may affect surgical outcomes by contributing to limitations in range of motion, strength, and functional recovery. The causes of postoperative pain are multifactorial; therefore, an appropriate pain management strategy must take into account preoperative, intraoperative, and postoperative factors to create a comprehensive and individualized plan for the patient. Preoperative assessment includes management of patient expectations, recognition of conditions and early counseling for high-risk patients (ie, opioid dependence, psychiatric comorbidities), and use of preemptive analgesia techniques (ie, preoperative IV medications, peripheral nerve blocks, incisional field blocks). Intraoperative strategies include meticulous surgical technique, limiting the use of tourniquets (ie, duration and pressure), and using preventive analgesia methods (ie, postoperative field block, continuous nerve catheters, intra-articular injection). Postoperative analgesia may be facilitated by cryotherapy, early mobilization, bracing, and rehabilitation. Certain modalities (ie, continuous passive motion devices, transcutaneous electrical nerve stimulation units, iontophoresis) may be important adjuncts in the perioperative period as well. There may be an evolving role for alternative medicine strategies. Early recognition and treatment of exaggerated postoperative pain responses may mitigate the effects of complex regional pain syndrome or the development of chronic pain.

Safety of Noninvasive Electrical Stimulation of Acupuncture Points During a Routine Neonatal Heel Stick.

Hospitalized infants may undergo frequent painful procedures with inadequate pain relief. Alternative pain relief interventions are needed. The aim of this research was to determine the safety of noninvasive electrical stimulation of acupuncture points (NESAP) in neonates who were receiving routine heel sticks. This was a descriptive study performed to assess the safety of using a transcutaneous electrical nerve stimulation (TENS) unit to deliver NESAP to neonates. The subjects were healthy newborn infants<3 days old before hospital discharge. The intervention was NESAP delivered via a TENS unit, administered before, during, and after heel stick. The electrodes of the TENS unit were applied at four acupuncture points. Settings were gradually increased: 6 infants received 1.0 mA, 2 Hz; the second 6 infants received 2.0 mA, 10 Hz; and the last 18 infants received 3.5 mA, 10 Hz. THREE MAIN MEASURES WERE USED: (1) skin assessment (2) vital signs; (3) pain scores using the Premature Infant Pain Profile (PIPP). There were no significant changes in vital signs during and after NESAP. There were no changes in PIPP scores in the first 12 infants after initiation of NESAP. A slight but nonsignificant increase in PIPP scores (from 2.65 to 3.5 on a scale of 0-18) occurred in the last 18 infants. There were no adverse events during or after NESAP. NESAP is safe for infants with low settings on a TENS unit.

The Argument for Medical Marijuana for the Treatment of Chronic Pain

This patient has legitimate pain and still deserves treatment despite being at high risk for substance abuse. Untreated pain will only create more drug hunger ⇓. Multimodal management would be best, including antidepressant and anticonvulsant medications, and physical modalities such as a transcutaneous electrical nerve stimulation unit ⇓. However, medicinal cannabis can be considered a legitimate next treatment step, much preferred to a prescription for opioids. Opioids and cannabinoids are both among the world's oldest drugs, with usage dating back thousands of years ⇓. Both medications work via specific receptors and are created …

Antiemetic efficacy of transcutaneous electrical nerve stimulation (TENS) at pericardium 6 acupuncture point (P6) in the treatment of chemotherapy-induced delayed nausea and vomiting (CINV) in stage I to III breast cancer patients during adjuvant/neoadjuvant chemotherapy (Ad/nAd).

TPS648 Background: CINV remain major adverse effects of highly emetic chemotherapy for breast cancer patients (BC). Patients (PT) rate nausea &amp; vomiting as the most feared chemotherapy-related symptoms. There is substantial evidence that P6 (located in the region in the middle of the wrist 3 finger breaths from the juncture of the hand &amp; wrist) acupuncture is an effective antiemetic treatment in a variety of PT including the post-anesthesia, obstetrical, and motion sickness PT. We hypothesized that application of TENS at P6 point will reduce:1) the overall incidence of CINV episodes in stage 1-3 BC PT, 2) the severity &amp; duration of CINV, 3) the requirement for rescue antiemetics 4) &amp; that TENS is well tolerated &amp; feasible. Maxima III Transcutaneous Electrical Nerve Stimulation unit is utilized in this study &amp; is self-administered by PT. Patients and Methods: We are conducting a prospective, randomized, double-blinded, controlled trial to determine if self-stimulating P6 may decrease the incidence and severity of delayed CINV in stage 1-3 BC treated with the initial dose of highly emetic Ad/nAd (AC, AC-T, TAC, TC, TCH) and reduce PT' need for rescue oral antiemetic medications. PT will be randomized in a 1:1 ratio to the active treatment group (TENS self-stimulation at P6) &amp; the control group (TENS self-stimulation at a point on the lateral side of the elbow that does not conform to any known acupuncture points). The assignments are blinded to the PT &amp; the investigators. Subjects self-administer TENS at home q4 hours for 20 minutes during days 2-5 postchemotherapy. The use of conventional antiemetic therapy (corticosteroids, setrons, aprepitant, phenergan &amp; prochlorperazine) is similar for both treatment groups. The severity of nausea symptoms, episodes of emesis, use of rescue antiemetics, and compliance are recorded daily by the PT in diaries. A brief questionnaire is also administered to evaluate PT tolerability of TENS &amp; their ability to comply with the treatment regimen. Twenty six out of 70 planned PT have been enrolled. Recruitment is ongoing.

Transcutaneous Electrical Nerve Stimulation for Treatment of Sarcoma Cancer Pain

SUMMARY Pain is often the initial presenting symptom with sarcomas. Upon resection of a sarcoma, most patients experience a resolution of their pain. However, in those patients with continued pain, treatment often requires multiple medications with moderate benefit. The authors present eight patients who suffer from continued sarcoma-related pain following resection of their initial cancer. For each patient, we describe the use of transcutaneous electrical nerve stimulation (TENS) for the treatment of sarcoma-related pain. Each patient was brought to the pain clinic for an initial four-lead trial of TENS lasting 30 min to determine the TENS setting that provided greatest pain relief. Patients were educated about the application and use of their TENS unit, which they self-utilized at home. Patients' pain response was monitored prior to the initial TENS trial and after 2 months of TENS use. Seven out of eight patients had a qualitative or quantitative reduction in their sarcoma-related pain. Three out of the seven patients demonstrated clinically significant (>30%) pain relief, while the other four patients demonstrated increased physical functionality and pain relief, during movement and rest. No patients experienced any adverse effects; however, TENS was stopped in one patient who had a beneficial response to TENS as that patient was found to have recurrent, widespread metastases of her sarcoma. Initial results indicate that TENS provides an easy-to-use, inexpensive therapeutic tool that can be used an adjunct in the treatment of sarcoma-related cancer pain. Future studies consisting of a large, randomized trial will be necessary to validate the efficacy of TENS in this patient population.

Transcutaneous Electric Nerve Stimulator Induced Inappropriate ICD Shock

Inappropriate shock delivered by implantable cardioverter defibrillators due to electromagnetic interference is a well-known phenomenon. This case report is about a new source of interference from a transcutaneous electronic nerve stimulation unit. Although the artifact from transcutaneous electronic nerve stimulation and interference with appropriate function of cardiac pacemakers is well documented, adverse interaction with implantable cardioverter defibrillators has rarely been reported. This case present a patient in whom a transcutaneous electrical nerve stimulation (a unit created an electrical artifact that was interpreted by a trans-venous implantable cardioverter defibrillators as ventricular fibrillation), led to the delivery of inappropriate therapy. Transcutaneous electrical nerve stimulation units should be used with caution in patients with implantable cardioverter defibrillators.

Role of physiotherapy in treatment of Rheumatoid Arthritis

R arthritis is a systemic auto-immune disease. Symmetrical inflammatory polyarthritis is the primary clinical manifestation. The arthritis usually begins in the small joints of the hands and the feet, spreading later to the larger joints. The inflamed joint lining or synovium extends and then erodes the articular cartilage and bone, causing joint deformity and progressive physical disability. RA is a disease where joints are commonly involved. The hands and wrists are affected in approximately 90% of RA patients, and these joints may show unique changes over time. Early in RA, joint tenderness and subtle swelling are observed, but after months to years the synovitis becomes proliferative and destructive. The tissue within the joint becomes boggy to the touch then typical joint deformities appear. Physiotherapy is can be used in the treatment of RA. These include: 1. Cold/hot applications 2. Electrical stimulation 3. Rest and splinting 4. Massage therapy 5. Therapeutic exercise. Cold/Hot application is well known that cold application is mostly used in acute stages whereas hot is used in chronic stages of RA. By using heat, analgesia is accomplished, muscle spasm relieved. Transcutaneous electrical nerve stimulation (TENS) is a widely used form of electro analgesia. TENS is thought to produce analgesia according to the gate control theory. The electrical stimuli delivered by TENS units can be varied to suit patient tolerance, as well as to produce the best efficacy. Massage Therapy is a commonly used treatment tool that improves flexibility, enhances a feeling of connection with other treatment modalities, improves general well being, and can help to diminish swelling of inflamed joints. Rest and Splinting treatment the joints should be put into rest during the acute stage of the disease. Bed rest relieves the pain in cases of extensive joint involvement. It is critical, at this stage, to put the joints into rest at a functional position. Orthosis and splinting are used to diminish pain and inflammation, to prevent development of deformities. Mitesh Patel, Orthop Muscul Syst 2013, 2:2 http://dx.doi.org/10.4172/2161-0533.S1.012

Trained long-term TENS users with chronic non-malignant pain. A retrospective questionnaire study of TENS usage and patients' experiences

Objectives: The aim was to examine self-administered long-term transcutaneous electrical nerve stimulation (TENS) usage along with patients' experiences in a group of patients with chronic regional non-malignant pain.Methods: All patients who had been selected to take part in a TENS trial at a university rehabilitation department during a 4-year period and had experienced initial pain-relief, were given personal units for home use. The TENS trials were performed by experienced professionals who gave careful instructions. One to four years later, 250 patients were sent a postal questionnaire focusing on: how TENS was used; degree of pain-relief; possible reasons for stopping using the technique; side effects; and patient experiences of trial and treatment follow-up procedures.Results: The response rate was 84% (n=210). One hundred and fifty-five (74%) patients were actively using TENS on a regular basis: 50 (32%) reported daily use and 55 (35%) use several times a week. The degree of pain-relief was reported by the active users on a four-category scale. Four (3%) patients reported 'Complete', 94 (61%) reported 'Some', and 47 (30%) reported 'Satisfactory' pain-relief. The duration of pain-relief was for 78 (50%) patients 1–4 hours, and for 23 (15%) patients 1–2 days or more. Other positive effects such as relaxation, less pain medication, better physical function were experienced by 71 (46%) patients, and 39 (25%) patients experienced adverse effects, most often related to handling problems or skin irritation.Discussion: This cross-sectional study indicates that three quarters of our patients continued to use their TENS units regularly for years, suggesting that they found it worthwhile to use TENS for pain relief.

Effectiveness of Imatinib Therapy for a Patient with Sickle Cell Anemia and Chronic Myelocytic Leukemia.

Abstract 2559Poster Board II-536 Background:To date, hydroxyurea (HU) is the only FDA-approved agent to treat sickle cell anemia (SCA). There is a need to identify alternative agents to prevent the complications of sickle cell disease. Clinical observations of patients receiving medications for other indications may provide insights into new opportunities. We present the clinical course of a patient with SCA and chronic myelocytic leukemia (CML) treated with imatinib. Case Report:A 24 year old woman with hemoglobin (Hb) SS had a variably elevated white blood cell (WBC) count for 3 years. WBC counts ranged from 11–39 × 103/cu mm; differential typically included 65–75% neutrophils, 15–20% lymphocytes, 1–13% metamyelocytes, and 1–3% myelocytes. Consistent with previous values, Hb ranged from 9–11 g/dL, and platelet counts from 250–400 × 103/cu mm. Real-time PCR for BCR-ABL obtained from the peripheral blood was positive. Bone marrow biopsy showed a markedly hypercellular marrow with granulocytic hyperplasia. Blasts were not increased in number. Cytogenetic studies revealed 46 XX, t(9;22)(q34;q11.2) in 20/20 analyzed cells. Further characterization by fluorescence in situ hybridization (FISH) technique demonstrated the loss of chromosome 9 long arm material. BCR-ABL interphase FISH confirmed the presence of 9/22 chromosomal translocation, found in 279/300 interphase nuclei. The patient was diagnosed with SCA in early childhood. Molecular analysis of genomic DNA revealed homozygosity for Hb S and single alpha-globin gene deletion of the rightward type. There was no evidence for typical deletions associated with HPFH or delta-beta zero thalassemia. The C>T polymorphism at nt −158 in the G-gamma-globin gene promoter region and other known HPFH point mutations in the G- or A-gamma globin genes were not identified. Her clinical course has not been complicated by stroke, pulmonary hypertension or acute chest syndrome. Radiographic studies revealed evidence of multiple bony infarcts. She was hospitalized with painful episodes 1-2 times per year, until the age of 16. At that time, her frequency of hospitalizations for painful episodes increased to 3-5 times per year, and showed a temporal relationship to her menses. She was started on oral contraceptives and hydroxyurea (HU) at the age of 18. Subsequently, hospitalizations for painful episodes decreased to 0-2 per year. At the age of 22, hydroxyurea was held during pregnancy. After delivery, HU was reinitiated and continued until the diagnosis of CML. She was hospitalized for painful episodes two times in the 12 months preceding the diagnosis of CML. Imatinib mesylate monotherapy at 400 mg/day was initiated. Two weeks later, a hematologic response was documented. At one year, bone marrow cytogenetic and molecular complete responses were documented. In the 17 months since initiation of imatinib, the patient has had a significant reduction in the frequency of painful episodes. No hospitalizations have been required and the patient has had a reduction in daily pain allowing discontinuation of a transcutaneous electrical nerve stimulation unit. During imatinib therapy Hb levels ranged from 8.0 to 9.2 g/dL, WBC counts from 3.3–6.1 × 103/cu mm, and platelet counts from 114–205 × 103/cu mm. Hemoglobin electrophoresis results are shown in the table.Hb FHb SPre-HU*26%71%Post-HU (n=7, mean)*35%63%Post-imatinib (n=2, mean)*34%64%Post-imatinib (by HPLC)20%74%*by gel electrophoresis Clinical Implications:To our knowledge, the clinical course of patients with SCA treated with imatinib has not previously been reported. Imatinib targets the BCR-ABL fusion tyrosine kinase, c-kit, and platelet-derived growth factor receptor. Myelosuppression is frequently noted as a side effect of this therapy. The improvement in this patient's sickle cell symptoms may be attributable to a reduction in the neutrophil count, as observed with HU therapy, but it is possible imatinib therapy had a positive effect on release of cytokines or other factors involved in vaso-occlusion. The Hb F level was not significantly increased with imatinib therapy. Evaluation of small molecule tyrosine kinase inhibitors in experimental models of SCA should be considered. Disclosures:No relevant conflicts of interest to declare.

The effect of tens on selected symptoms in the management of patients with chronic tension type headache: A preliminary study

Headache is one of the most frequent causes of consultation in both general medical practice and neurological clinics. It is the most common of all medical conditions causing pain and disability. Headache is experienced by 90% of the general population at some point in life, as a consequence of febrile illness. However, primary headache occur in some people on chronic basis such as tension headache, and require long-term relief. This study was aimed at investigating the efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) on Pain, Functional Disability and Cervical Range of Motion in patients with Chronic Tension Type Headache (CTTH). Eight (8) subjects aged 20-50 years with diagnosis of CTTH participated in the study. The subjects were treated thrice weekly for ten (10) weeks with an EV904 TENS unit made by Electromedical Supplies, at a pulse rate of 4Hz and pulse width of 200micros. Pain level, Functional Disability and Cervical Range of Motion were determined using the Visual Analogue Scale (VAS), Headache Disability Index (HDI) and Universal Goniometer respectively. Data was analyzed using the Wilcoxon Signed Ranks Test for pain and functional disability while unpaired t-test was used to analyze cervical range of motion. Level of significance was set at p < 0.05. The result showed a significant reduction in pain and functional disability with a significant improvement of cervical range of motion within the studied subjects. Based on the findings of this study, it was therefore concluded that TENS application should be considered in the long-term management of patients with CTTH.

Transcutaneous electrical nerve stimulation (TENS) for pain management in labour

Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. The TENS unit is frequently operated by women, which may increase sense of control in labour. To assess the effects of TENS on pain in labour. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008). Randomised controlled trials comparing women receiving TENS for pain relief in labour versus routine care, alternative pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines. Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies. The search identified 25 studies; we excluded six and included 19 studies including 1671 women. Fifteen examined TENS applied to the back, two to acupuncture points and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32 to 0.55). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No adverse events were reported. There is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact (either positive or negative) on other outcomes for mothers or babies. The use of TENS at home in early labour has not been evaluated. TENS is widely available in hospital settings and women should have the choice of using it in labour.

Evaluation of the effects of transcutaneous electrical nerve stimulation on whole saliva flow: A clinical study

Background and Objectives : Xerostomia and salivary gland hypofunction are associated with advancing age, autoimmune diseases such as Sjφgren's syndrome, head and neck radiation, smoking and recreational drug usage. Palliative management of xerostomia includes topical agents such as ice chips, saliva substitutes, increasing water intake, paraffin and citric acid containing lozenges. Systemic agents have been used, but some drugs have been found to have unfavorable side effects. Therefore, this study was undertaken to evaluate the effect of transcutaneous electrical nerve stimulation (TENS) on whole salivary flow rate in healthy adult subjects. Study Design : One hundred healthy adult subjects (50 males and 50 females), with no history of salivary gland disorder, were enrolled in this study. TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated whole saliva was collected for five minutes in a graduated tube, using a standardized collection technique. The TENS unit was then activated and stimulated saliva was collected for an additional five minutes. Results : Eighty five of the 100 subjects demonstrated increased whole salivary flow when stimulated via the TENS unit. Eleven experienced no change and four experienced a decrease in the salivary flow. The mean unstimulated salivary flow rate was 0.36 ml/min (SD 0.16) and there was a 21% increase in the salivary flow following TENS application. Statistical analysis of flow rates utilizing the paired 't' test showed the difference to be statistically significant ( P Interpretation and Conclusion : The TENS unit was effective in increasing whole salivary flow in 85% of the healthy adult subjects. A further study in patients with xerostomia, secondary to various local and systemic causes, is required.

Anesthesia for Ophthalmologic Surgery

Johns Hopkins School of Medicine, Baltimore, Maryland. BourkedenisL@aol.comI would like to make several comments regarding the excellent article by Vann et al. 1First, I would encourage anesthesiologists to resist the use of topical anesthesia for ophthalmologic surgery except when the most competent surgeons are doing straightforward procedures in healthy patients. I have been caught several times when cataract surgery went awry and a retinal surgeon had to be called in urgently to perform surgery that could not be tolerated using topical anesthesia alone. The alternatives are to stop the procedure and induce emergent general anesthesia or to induce very deep sedation without control of the airway. A sub-Tenon, peribulbar, or retrobulbar block would have prevented the added risks of either of the above alternatives.Second, I have performed several hundred retrobulbar blocks without using any premedication or sedation. In addition, I have been the anesthesiologist during many other retrobulbar or peribulbar blocks performed by the surgeon without any premedication or sedation. In the vast majority of cases, all that is required is a little hand-holding, encouragement, and empathy. Occasionally, for patients with high anxiety or a low pain threshold, a transcutaneous electrical nerve stimulation unit with the electrodes placed on the temple and forehead virtually eliminates any discomfort. It is the rare patient who must have something like propofol for the block.With a little preparation by the surgeon and anesthesiologist, it is seldom that any medication at all is required for ophthalmologic surgery. The less medication is used, the more alert and cooperative the patient will be and the less likely the patient will be to fall asleep, suddenly awaken, and move during surgery. To me, the risk–benefit ratio clearly favors the major block without sedation.Johns Hopkins School of Medicine, Baltimore, Maryland. BourkedenisL@aol.com

TENS to the Lateral Aspect of the Knees During Stance Attenuates Postural Sway in Young Adults

Somatosensory input is known to be essential for postural control. The present study examined the effects on postural sway of sensory input delivered via transcutaneous electrical nerve stimulation (TENS) applied to the knees during stance. Electrodes from a dual-channel portable TENS unit were adhered to the skin overlying the lateral and medial aspect of both knees of 20 young healthy volunteers (mean age 24.0 years, standard deviation 4.0). Postural sway parameters were obtained during static bipedal stance with an AMTI force platform. Four stimulation conditions were tested with eyes open and with eyes closed: no TENS; TENS applied bilaterally; and TENS applied to either the right or the left knee. Participants underwent two eight-trial blocks, with each trial lasting 30 seconds. The order of conditions was randomized for each participant. Stimulation consisted of a biphasic symmetrical stimulus delivered at the sensory detection level, with a pulse duration of 200μsec and a pulse frequency of 100Hz. The application of TENS induced significant reductions in mean sway velocity and in the medio-lateral dispersion of the center of pressure, with no corresponding effect on the anterior-posterior dispersion. These findings suggest that electrical stimulation delivered at the sensory detection level to the lateral aspects of the knees may be effective in improving balance control, and that this effect may be directionally specific.

Differences in Waveform Characteristics Have No Effect on the Anti-Hyperalgesia Produced by Transcutaneous Electrical Nerve Stimulation (TENS) in Rats With Joint Inflammation

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological method for pain management. Commercial TENS units differ in their waveform characteristics. However, effects of different waveforms on analgesia produced by TENS are unknown. Therefore, we compared effects of high-frequency TENS with different waveforms--asymmetric biphasic square and symmetric biphasic square--on inflammatory hyperalgesia. Paw withdrawal latency to heat (PWL) was assessed prior to inflaming the knee joint with 3% carrageenan/kaolin in rats. Four hours after induction of inflammation, PWL significantly decreased in all groups, indicating development of hyperalgesia. High-frequency TENS was then applied to the inflamed knee joint for 20 minutes while the rat was lightly anesthetized with halothane. TENS treatment with either the asymmetric or symmetric waveform significantly increased the PWL when compared with sham TENS. Thus, differences in waveform characteristics do not affect the anti-hyperalgesia produced by TENS. This study shows that different waveforms of TENS do not affect analgesic efficacy. This suggests that clinicians can select different waveforms to provide comfort during treatment but that reduction in pain is not a factor for waveform selection.

Transcutaneous electrical nerve stimulation: Intervention for pain and disability associated with ultrasonography

AND DISABILITY ASSOCIATED WITH ULTRASONOGRAPHY NORA DOYLE, MILDRED M. RAMIREZ, MICHAEL GARDNER, JOAN M. MASTROBATTISTA, University of Texas Health Science Center at Houston, Obstetrics, Gynecology, and Reproductive Sciences, Houston, Texas, Baylor College of Medicine, Obstetrics and Gynecology, Houston, Texas OBJECTIVE: The incidence of musculoskeletal injuries (MSI) among sonographers and sonologists is increasing with resultant lost work days having a significant negative impact on the delivery of ultrasound services. Transcutaneous electrical nerve stimulation (TENS) is used clinically by a variety of health care professionals for pain reduction. Mechanism of action is supported by the gate control pain theory and release of endogenous opioids. We sought to evaluate the efficacy and practicality of using a TENS unit by obstetrical sonographers in the workplace. STUDY DESIGN: Baseline demographic information, ergonomics survey and Upper Extremity Function Scale (Pransky) (UES) was obtained from all participants (n = 8) prior to device application. TENS unit was used by participants during a normal work day with subject control of intensity and duration. Post use information was then collected. RESULTS: Participants were female, age 25-57, with mean BMI 26.2 for the group. Ethnicity was 6 white and 2 Hispanic. All engaged in regular physical activity and reported good to excellent health. All performed ultrasounds 5 days/ week with >30 scans/week with no interventions currently being used at work. All were right hand dominant and scanned using their right hand. All reported wearing comfortable shoes and adjusting patient bed height when possible, with no other ergonomic interventions used. All reported pain after becoming a sonographer, with 2 missing work because of the pain. Satisfaction with using the TENS during work for relief of pain symptoms was high with all 8 saying they would use it again and 6 saying they would recommend it to others. CONCLUSION: Repetitive use injuries are a growing concern in sonographers and sonologists. TENS is a low cost, noninvasive modality that is easy to apply with few contraindications. Our study suggests it can sensibly be used in the workplace to relieve pain symptoms associated with performance of ultrasound. 648 ULTRASONOGRAPHIC MEASUREMENT OF FETAL NASAL BONE IN THE KOREAN POPULATION AT THE FIRST AND SECOND TRIMESTER EUI JUNG, HYE-SUNG WON, JUNG-SUN KIM, JAE-YOON SHIM, PIL RYANG LEE, AHM KIM, Asan Medical Center, University of Ulsan, Obstetrics and Gynecology, Seoul, South Korea, Asan Medical Center, University of Ulsan, Pathology, Seoul, South Korea OBJECTIVE: To establish the reference range of fetal nasal bone length(NBL) at the 1st and 2nd trimester in the Korean population and to determine the accuracy of prenatal NBL by postmortem examination including radiographs and autopsy. STUDY DESIGN: A total of 404 consecutive ultrasound examinations were performed at 11-14 weeks of gestation for nuchal translucency and nasal bone measurement and 820 consecutive fetuses underwent ultrasound examination at 18-26 weeks of gestation in Asan Medical Center. And the association between chromosomal abnormality and nasal bone absence or hypoplasia(smaller than 2.5th percentile) was analysed. Twenty-two fetuses with congenital anomaly or intrauterine death had undergone sonographic measurement of NBL before termination of pregnancy and were examined by radiographs and autopsy following termination. RESULTS: At the 1st trimester, the visualization of fetal profile was obtained in 398 fetuses (98.5%), and linear regression was performed. The incidence of nasal bone absence was 3/398 (0.75%). One fetus had T.21, one with T.18 and the other was acrania with euploidy. At the 2nd trimester, fetal profile was successfully examined in 818 fetuses(99.8%) and the NBL increased linearly with gestation. During this period, 6 fetuses with chromosomal abnormality (including 2 T.21) were detected and only one fetus with T.21 had hypoplastic nasal bone. Hypoplastic nasal bones was seen in 14/812 (1.7%) chromosomally normal fetuses. NBL measured by ultrasound was similar to that confirmed by autopsy and longer than by postmortem radiograph. CONCLUSION: We present the normal range of NBL at the 1st and 2nd trimester and their linear relationship with CRL and gestational age. Although numerically limited, our experience shows that the NBL in the 2nd trimester in Korean seems to be shorter than that of Caucasian and similar to Chinese. So different normal ranges for different races are required, and relative percentile is more reliable than absolute value. And the accuracy of the NBL measured by ultrasonography was confirmed by postmortem autopsy.