Transcutaneous Nerve Stimulation Research Articles

Effect of Transcutaneous Electrical Nerve Stimulation of T6 Dermatome on Appetite and Weight Reduction in Obese Individuals: A Pilot Study

Background: Previous work demonstrated the beneficial effect of T6 dermatomal stimulation by the percutaneous method in managing obesity. However, a simple, cost-effective, and feasible intervention stimulating the dermatome can be a potential solution for obesity care. Objective: The objective of this study was to find the effect of transcutaneous electrical nerve stimulation (TENS) of T6 dermatome on appetite and weight loss in obese individuals. Material and Methods: In this prospective single-arm experimental study, 20 obese patients received TENS treatment of T6 dermatome for 30 min, once a week and for 12 weeks. Outcome measures such as appetite level in the visual analog scale (VAS), weight in kg, and basal metabolic index (BMI) in kg/m2 were assessed at baseline, 12 weeks -post-intervention, and at 8 weeks of follow-up. Results: A statistically significant difference in all the variables was found from baseline to 12 weeks of intervention (P < 0.001) and maintained till 8 weeks of follow-up. From pre- to post-treatment, the effect size for appetite reduction was large (>1) while for weight and BMI loss was (0.14, 0.16), respectively small. Additionally, a weak correlation was found between pre- and follow-up appetite and weight loss (r = 0.25, P = 0.294). Conclusions: Twelve weeks of TENS treatment of T6 dermatome showed a positive effect in reducing appetite with sustained reduction up to 8 weeks of follow-up even after completion of the intervention. However, in the absence of dietary modification, TENS treatment was associated with low effect sizes weight and BMI loss.

Transcutaneous vagus nerve stimulation modulates depression-like phenotype induced by high-fat diet via P2X7R/NLRP3/IL-1β in the prefrontal cortex.

Depression is a common psychiatric disorder in diabetic patients. Depressive mood associated with obesity/metabolic disorders is related to the inflammatory response caused by long-term consumption of high-fat diets, but its molecular mechanism is unclear. In this study, we investigated whether the antidepressant effect of transcutaneous auricular vagus nerve stimulation (taVNS) in high-fat diet rats works through the P2X7R/NLRP3/IL-1β pathway. We first used 16S rRNA gene sequencing analysis and LC-MS metabolomics assays in Zucker diabetic fatty (ZDF) rats with long-term high-fat diet (Purina #5008) induced significant depression-like behaviors. Next, the forced swimming test (FST) and open field test (OFT) were measured to evaluate the antidepressive effect of taVNS. Immunofluorescence and western blotting (WB) were used to measure the microglia state and the expression of P2X7R, NLRP3, and IL-1β in PFC. Purina#5008 diet induced significant depression-like behaviors in ZDF rats and was closely related to purine and inflammatory metabolites. Consecutive taVNS increased plasma insulin concentration, reduced glycated hemoglobin and glucagon content in ZDF rats, significantly improved the depressive-like phenotype in ZDF rats through reducing the microglia activity, and increased the expression of P2X7R, NLRP3, and IL-1β in the prefrontal cortex (PFC). The P2X7R/NLRP3/IL-1β signaling pathway may play an important role in the antidepressant-like behavior of taVNS, which provides a promising mechanism for taVNS clinical treatment of diabetes combined with depression.

An update on noninvasive neuromodulation in the treatment of patients with prolonged disorders of consciousness.

With the improvement of emergency techniques, the survival rate of patients with severe brain injury has increased. However, this has also led to an annual increase in the number of patients with prolonged disorders of consciousness (pDoC). Hence, recovery of consciousness is an important part of treatment. With advancing techniques, noninvasive neuromodulation seems a promising intervention. The objective of this review was to summarize the latest techniques and provide the basis for protocols of noninvasive neuromodulations in pDoC. This review summarized the advances in noninvasive neuromodulation in the treatment of pDoC in the last 5 years. Variable techniques of neuromodulation are used in pDoC. Transcranial ultrasonic stimulation (TUS) and transcutaneous auricular vagus nerve stimulation (taVNS) are very new techniques, while transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) are still the hotspots in pDoC. Median nerve electrical stimulation (MNS) has received little attention in the last 5 years. Noninvasive neuromodulation is a valuable and promising technique to treat pDoC. Further studies are needed to determine a unified stimulus protocol to achieve optimal effects as well as safety.

Temporal Variability in Stride Kinematics during the Application of TENS: A Machine Learning Analysis.

The purpose of our report was to use a Random Forest classification approach to predict the association between transcutaneous electrical nerve stimulation (TENS) and walking kinematics at the stride level when middle-aged and older adults performed the 6-min test of walking endurance. Data from 41 participants (aged 64.6 ± 9.7 yr) acquired in two previously published studies were analyzed with a Random Forest algorithm that focused on upper and lower limb, lumbar, and trunk kinematics. The four most predictive kinematic features were identified and utilized in separate models to distinguish between three walking conditions: burst TENS, continuous TENS, and control. SHAP analysis and linear mixed models were used to characterize the differences among these conditions. Modulation of four key kinematic features-toe-out angle, toe-off angle, and lumbar range of motion (ROM) in coronal and sagittal planes-accurately predicted walking conditions for the burst (82% accuracy) and continuous (77% accuracy) TENS conditions compared with control. Linear mixed models detected a significant difference in lumbar sagittal ROM between the TENS conditions. SHAP analysis revealed that burst TENS was positively associated with greater lumbar coronal ROM, smaller toe-off angle, and less lumbar sagittal ROM. Conversely, continuous TENS was associated with less lumbar coronal ROM and greater lumbar sagittal ROM. Our approach identified four kinematic features at the stride level that could distinguish between the three walking conditions. These distinctions were not evident in average values across strides.

THE EFFECT OF ADMINISTERING TENS COMBINED WITH ISOMETRIC EXERCISES ON PAIN VALUES AMONG PATIENTS WITH KNEE OSTEOARTHRITIS AT THE IHC LAVALETTE HOSPITAL MALANG

Osteoarthritis causes changes within the digestion system of joint cartilage. These changes are within the shape of an increment within the action of chemicals that damage the macromolecules of the joint cartilage network, went with by a diminish within the blend of collagen and proteoglycans. This causes a decrease in proteoglycan levels, changes in the properties of collagen and reduced water content in joint cartilage causing pain in the knee. In this research, researchers used quantitative research methods or tested directly.The inquire about plan utilized by analysts is one bunch pretest-posttest plan. Within the One-Group Pretest-Posttest Plan the subordinate variable is measured as one bunch some time recently (pretest) and after (posttest) a treatment is given. The sample used in this study was 15 respondents who were given a combination of Transcutaneous Electrical Nerve Stimulation and isometric exercises. P value = 0.001 < 0.05 Conclusion: H0 is rejected. H1 is accepted. There's a noteworthy impact of giving a combination of Transcutaneous Electrical Nerve Incitement and isometric works out on torment scores in patients with knee osteoarthritis at Lavalette Hospital, Malang.

The application of extracorporeal shock wave therapy in the treatment of temporomandibular joint disorders in a preliminary, small sample study.

The aim of this study was to investigate the efficacy of low-intensity, high-frequency shock waves in the treatment of temporomandibular joint disorders. Twenty-six patients with temporomandibular joint disorder admitted to the Second Hospital of Shanxi Medical University from August 2022 to December 2022 were selected as study subjects and randomly divided into two groups, A and B, with 13 patients each. In Group A, there were 5 males and 8 females with an average age of 38.85 ± 11.03 years. In Group B, there were 4 males and 9 females with an average age of 39.15 ± 11.16 years. Group A was the control group, which received routine treatment (manual massage + transcutaneous electrical nerve stimulation + ultrashort wave therapy) plus sham shock wave therapy; Group B was the experimental group, which received routine treatment (manual massage + transcutaneous electrical nerve stimulation + ultrashort wave therapy) plus shock wave therapy. The routine treatment was administered once/day, five times per week for a total of 2 weeks of treatment. In addition, shock wave therapy was administered once every 5 days, and the treatment was administered three times. The treatment period was 2 weeks, and the two groups were compared before treatment, at the end of the treatment period, and 4 weeks after treatment. The pain level of the two groups was assessed by the visual analogue scale (VAS) before and after treatment, and the temporomandibular opening index (TOI) before and after treatment was compared between the two groups. VAS and TOI scores were evaluated using the Mann-Whitney U-test, the Kruskal-Wallis H-test and two-way ANOVA. There was no significant difference in the VAS score and temporomandibular opening index between the two groups before treatment (p = .829 and .75, respectively). After 2 weeks of treatment, the VAS score and temporomandibular joint opening index of both groups were significantly improved compared to those before therapy. In addition, the VAS score and temporomandibular joint opening index in the experimental group were significantly better than those in the control group (p < .001 and <.001, respectively). There was a small increase in scores 4 weeks after the treatment compared to just after the treatment period, but the difference was not significant. This is a preliminary small sample study that demonstrates the positive effect of using low-intensity, high-frequency shock waves on the treatment of temporomandibular joint disorders and is worthy of clinical promotion.

Transcutaneous Auricular Vagus Nerve Stimulation in Adolescent Treatment Resistant Depression—A Case Report

Adolescence is a critical time period for the onset of depression and many patients do not respond to treatment. Transcutaneous auricular vagus nerve stimulation (taVNS) may be a promising alternative. Here we present the case of an adolescent girl with treatment resistant depression, receiving taVNS over the course of 7.5 months.

Comparison of short-wave diathermy, Transcutaneous electrical nerve stimulation of electrotherapy methods and exercise therapy in chronic low back conditions

Background: Low back pain is a significant contributor to global disability, impacting individuals across different age groups. Research suggests that around 80% of people will encounter low back pain at some stage in their lives. This condition is more prevalent among middle-aged and elderly individuals, with a higher occurrence among females. The socioeconomic consequences of low back pain are substantial, including increased healthcare expenses, absenteeism from work, and a diminished quality of life. Objective: To compare the effectiveness of short-wave diathermy with exercise, transcutaneous electrical nerve stimulation with exercise, and exercise alone among patients with chronic low back pain. Patients and Methods: 75 patients who were diagnosed with chronic low back pain, ages 20–50, participated. They were divided into three groups: group A received shortwave with exercise, group B received TENS with exercise, and group C received just exercise. Treatment was given for 12 sessions over a period of 4 weeks. All patients were evaluated before and after treatment using a visual analog scale and the Oswestry Low Back Pain Disability Questionnaire. Results: The results showed that all three interventions were effective in reducing pain and improving physical activities, with varying degrees of success. But also, the result showed that the mean difference for the short wave with exercise is much higher than both the TENS with exercise and the exercise alone types of interventions in each of the different categories, respectively. Conclusion: This study has shown that shortwave exercise is more effective in the treatment of chronic low back pain than TENS with exercise and exercise alone.

Comparison of short-wave diathermy, Transcutaneous electrical nerve stimulation of electrotherapy methods and exercise therapy in chronic low back conditions

Background: Low back pain is a significant contributor to global disability, impacting individuals across different age groups. Research suggests that around 80% of people will encounter low back pain at some stage in their lives. This condition is more prevalent among middle-aged and elderly individuals, with a higher occurrence among females. The socioeconomic consequences of low back pain are substantial, including increased healthcare expenses, absenteeism from work, and a diminished quality of life. Objective: To compare the effectiveness of short-wave diathermy with exercise, transcutaneous electrical nerve stimulation with exercise, and exercise alone among patients with chronic low back pain. Patients and Methods: 75 patients who were diagnosed with chronic low back pain, ages 20–50, participated. They were divided into three groups: group A received shortwave with exercise, group B received TENS with exercise, and group C received just exercise. Treatment was given for 12 sessions over a period of 4 weeks. All patients were evaluated before and after treatment using a visual analog scale and the Oswestry Low Back Pain Disability Questionnaire. Results: The results showed that all three interventions were effective in reducing pain and improving physical activities, with varying degrees of success. But also, the result showed that the mean difference for the short wave with exercise is much higher than both the TENS with exercise and the exercise alone types of interventions in each of the different categories, respectively. Conclusion: This study has shown that shortwave exercise is more effective in the treatment of chronic low back pain than TENS with exercise and exercise alone. Keywords: Shortwave, TENS, Exercise, Chronic low back pain.

Possible mechanisms of auricular acupoint stimulation in the treatment of migraine by activating auricular vagus nerve.

Under the guidance of traditional Chinese medicine theory, the clinical research of auricular acupoint stimulation in the treatment of migraine has gained a lot, and the curative efficacy is definite, but its mechanism remains unclear. In the present paper, we discussed the efficacy of auricular acupoint stimulation including "transcutaneous auricular vagus nerve stimulation" (taVNS) in the treatment of migraine in recent years. Through bibliometric analysis, we screened out top 10 auricular acupoints (Shenmen［TF4］, Pizhixia［AT4］, Jiaogan［AH6a］, Gan［CO12］, Yidan［CO11］, Neifenmi［CO18］, Shen［CO10］, Nie［AT2］, Zhen［AT3］ and E［AT1］) which were the most frequently used for migraine. Majority of these auricular acupoints just distributed in the region innervated by auricular vagus nerve. Thus, we thought that the analgesic effect of needling these auricular acupoints for migraine was produced by triggering the auricular vagus nerve, and concluded that the central mechanism underlying induction of analgesic effect by activating auricular vagus nerve may be achieved by activating the descending pain regulation pathway of the locus coeruleus nucleus and dorsal raphe nucleus. In addition, taVNS-induced 1) regulation of the activities of brain's default network and pain matrix, 2) activation of the cortical descending pain regulation pathway, and 3) inhibition of the neuroinflammatory response may also contribute to its ameliorating effect of migraine. This paper may provide ideas for the future research on the mechanism of auricular acupoint treatment of migraine.

Transcutaneous electric nerve stimulation of acupuncture points improves tolerance in adults undergoing diagnostic upper gastrointestinal endoscopy: a single-center, double-blinded, randomized controlled trial.

Oesophagogastroduodenoscopy (OGDS) is the most common diagnostic procedure for upper gastrointestinal diseases. It often causes discomfort and anxiety, which are only mitigated by systemic sedation. However, sedation poses additional risks of adverse cardiopulmonary events, increased medical costs, and prolonged recovery. Transcutaneous electrical nerve stimulation of acupuncture points (Acu-TENS) is a non-invasive and innovative approach that induces analgesic effect during endoscopy. This trial is the first to be reported in English that explores the potential of Acu-TENS to increase patient tolerance during non-sedated elective diagnostic OGDS. A double-blinded randomized controlled trial involving 348 subjects was conducted at a tertiary hospital to evaluate the success rate of OGDS with Acu-TENS. Subjects aged 18-75years scheduled for their first elective diagnostic OGDS were randomized into the intervention (Acu-TENS) and placebo arms. OGDS success was assessed based on subjects' satisfaction ratings on a Likert scale and procedure's technical adequacy. Secondary measures included subjects' willingness to undergo future OGDS under similar conditions, procedure duration, and the endoscopist's perceived ease of the procedure. OGDS success rates were significantly higher with Acu-TENS (77.8%) than with the placebo (68.0%; odds ratio [OR] 1.64, 95% confidence interval [CI] 1.01-2.66, p = 0.043). Subjects who received Acu-TENS expressed higher willingness for future OGDS (78.9%) than those who received the placebo (68.6%; OR 1.71, 95% CI 1.04-2.79, p = 0.031). Procedure duration were significantly shorter in the intervention arm (6.0min) than in the placebo arm (10.0min; p = 0.002). No adverse effects were reported, and endoscopists perceived similar procedure ease in both arms. Acu-TENS improved OGDS success and enhanced patients' experiences during non-sedated OGDS. It demonstrated safety with no side effects and reduced the procedure completion time. It could be used as an adjunct in non-sedated diagnostic OGDS.

Holistic approaches to living well with endometriosis

Endometriosis is a common chronic condition for which there is currently no cure. Those suffering from endometriosis-related pelvic pain (ERPP) may struggle with side effects and/or risks presented by conventional medical and surgical treatment strategies, or not get pain relief. Increasing numbers of endometriosis patients wish to explore holistic management with fewer side effects, however it is important that medical professionals maintain an evidence-based practice for recommended treatments. We present up-to-date evidence of holistic strategies used for managing ERPP including nutritional strategies, body and mind therapies, acupuncture, traditional Chinese medicine (TCM) and the use of adjunct devices such as phallus length reducers and transcutaneous electrical nerve stimulation (TENS). Recent findings Nutrition: Gluten-free, low-nickel and high intake of omega-3 polyunsaturated fatty acids diets improve ERPP. Low FODMAP (fermentable oligo-, di-, monosaccharides and polyols) is helpful in those with concurrent irritable bowel syndrome. Body and mind: Cognitive behaviour therapy (CBT) is particularly beneficial in postoperative pain reduction, whilst mindfulness has been shown to reduce pain scores and dyschezia. Progressive muscle relaxation therapy and regular yoga sessions improve ERPP and Quality of life. Acupuncture: 15 randomised control trials assessing acupuncture and moxibustion show improved pain scores when compared to those receiving conventional therapies alone. Adjunct devices: TENS improves deep dyspareunia and lessens the number of days pain is experienced. Conclusions Holistic management strategies for ERPP should be incorporated into routine counselling when discussing conservative, medical and or surgical treatments for endometriosis. The growing evidence presented for the use of holistic management strategies gives hope to those patients who cannot have, or don’t respond to conventional approaches and as an adjunct alongside standard treatments.

The effect of physical therapy rehabilitation on fatigue and pain in female patients with fibromyalgia

This study aimed to examine the impact of physical therapy rehabilitation program on fatigue, pain and quality of life in female patients with fibromyalgia. It was designed as a single-blinded, randomized, pre and post-test controlled trial. Eighty female patients, aged 25 to 45, diagnosed with fibromyalgia were selected from the Kasr Al Ainy rheumatology outpatient clinic. The participants were allocated into two equal groups using a randomization procedure. Group (A) (control group, n=40) received transcutaneous electric nerve stimulation (TENS), moist heat, core muscle retraining, and manual therapy for trigger points, 3 times/week, for 4 weeks. Group (B) (study group, n=40) received the same treatments as Group A, plus aerobic exercises, flexibility exercises, and cognitive behavioural therapy (CBT), 3 times/week, for 4 weeks. Both groups were assessed before and after treatment using the Fatigue Severity Scale (FSS) and the Fibromyalgia Impact Questionnaire (FIQ). Statistically significant improvements were observed in FSS and FIQ scores for both groups post-treatment (p&lt;0.05). When the two groups were compared after therapy, the study group (B) showed significantly greater improvement in FSS and FIQ (p&lt;0.05). These findings suggest that physical therapy rehabilitation can effectively reduce fatigue, pain, and improve the quality of life for women with fibromyalgia.

Patients’ perioperative experiences of an opioid-free versus opioid-based care pathway for laparoscopic bariatric surgery: A qualitative study

BackgroundDespite recent evidence supporting the adoption of opioid-free anaesthetic and analgesic alternatives in the perioperative context, opioid-based regimens remain standard of care. There is limited knowledge about the patients’ perioperative experiences of bariatric surgery, with no study yet investigating their experiences within an opioid-free care pathway. ObjectiveWe aimed to describe similarities and differences in patients’ perioperative experiences of undergoing bariatric surgery with either an opioid-free or opioid-based care pathway. DesignA qualitative interview study SettingA strategic sample of patients enrolled in an ongoing randomized controlled trial investigating the effects of opioid-free anaesthesia for bariatric surgery were recruited. In the randomized controlled trial, participants were randomized to either opioid-based anaesthesia or opioid-free anaesthesia, including transcutaneous electrical nerve stimulation as primary postoperative pain management. ParticipantsTwenty patients were interviewed 3 months after surgery: 10 participants in the opioid-free group versus 10 in the opioid-based group. MethodsSemi-structured interviews were conducted between December 2020 and February 2022 and analysed with qualitative content analysis. ResultsThe analysis yielded four categories and 12 subcategories. In Category 1, participants shared diverse emotions before surgery, including anticipation of a healthier life, but also apprehensions and feelings of failure. In Category 2, describing liminality of general anaesthesia, there were similar descriptions of struggling to remember the anaesthesia induction and struggling to surface when recovering from anaesthesia. However, some participants in the opioid-free group shared descriptions of struggling to keep control, describing accentuated memories of the anaesthesia induction. Category 3, managing your pain, showed similar experiences and strategies but different narrations of pain management, with the opioid-free group stating that transcutaneous electrical nerve stimulation works but not when it really hurts, and the opioid-based group describing confidence in but awareness of opioids. Throughout the overall perioperative time period, participants acknowledged Category 4, a patient-professional presence, stating that preparations boost the feeling of confidence before surgery and that they felt confidence in a vulnerable situation although vulnerability challenges communication. ConclusionsWe highlighted the overall similarities in perioperative experiences of patients undergoing bariatric surgery. However, the differences in experiences during opioid-free anaesthesia induction need to be addressed in further implementation and research studies investigating strategies to reduce the sense of loss of control. More research is needed to facilitate the implementation of opioid-free treatment strategies into clinical practice and improve the patient care experience.

THE EFFECTS OF TRANSCUTANEOUS AURICULAR VAGUS NERVE STIMULATION ON NERVE CONDUCTION VELOCITY, GRIP STRENGTH, PAIN, AND UPPER EXTREMITY FUNCTIONALITY IN INDIVIDUALS WITH CARPAL TUNNEL SYNDROME

Purpose: This study aims to investigate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) on key parameters, including nerve conduction velocity, grip strength, pain, and upper extremity functionality in individuals with carpal tunnel syndrome (CTS). Methods: The study involved 51 patients (90 hands) diagnosed with carpal tunnel syndrome, comprising 12 males and 39 females, ranging in age from 18 to 58 years. Participants were divided into groups by random randomization method. Sensory branch conduction velocity of the median nerve was assessed via electromyography (EMG), hand grip strength was measured using a digital dynamometer, and pain intensity was quantified with a visual analog scale (VAS); additionally, upper extremity functionality was evaluated using the Upper Extremity Functional Index (UEFI) scale before and after the treatment. In the experimental group, in addition to the conventional physiotherapy program, 10 sessions of auricular vagus nerve stimulation were administered; for the sham and control groups, the conventional physiotherapy program alone was conducted over the course of 10 sessions. Results: The analysis revealed no statistically significant differences between the groups concerning variables such as body mass index (BMI), age, gender, educational background, and smoking status (p&gt;0.05). However, within-group evaluations exhibited significant differences compared to baseline values in terms of nerve conduction velocity, pain perception, and upper extremity functionality, with no such difference observed in grip strength (p

0280 Effect of Daily Transcutaneous Vagal Nerve Stimulation on Objective and Subjective Sleep Features in Healthy Adults

0280 Effect of Daily Transcutaneous Vagal Nerve Stimulation on Objective and Subjective Sleep Features in Healthy Adults

Neuropathic pain: Evidence based recommendations

Neuropathic pain continues to be a significant problem that lacks effective solutions for every single patient. In 2015, international guidelines (NeuPSIG) were published, while the French recommendations were updated in 2020. The purpose of this minireview is to provide an update on the process of developing evidence-based recommendations and explore potential changes to the current recommendations. Primary treatments for neuropathic pain include selective serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine, gabapentin, tricyclic antidepressants, as well as topical lidocaine and transcutaneous electrical nerve stimulation, which are specifically suggested for focal peripheral neuropathic pain. Pregabalin is a first line treatment according to international guidelines but second-line in the more recent French guidelines, due to lower efficacy seen in more recent studies and misuse risk. Additionally, tramadol, combination therapies, and psychotherapy as adjuncts are proposed second line; high-concentration capsaicin patches, and botulinum toxin A are proposed specifically for focal peripheral neuropathic pain. In cases where primary and secondary treatments prove insufficient, third-line options come into play. These include high-frequency repetitive transcranial magnetic stimulation (rTMS) targeting the motor cortex, spinal cord stimulation, and the use of strong opioids when no alternative is available. To ensure optimal management of neuropathic pain in real-life situations, it is imperative to disseminate these recommendations widely and secure the acceptance of practitioners. By doing so, we can bridge the gap between theory and practice, and enhance the overall care and treatment of individuals suffering from neuropathic pain.

Pharmacotherapy and noninvasive neurostimulation for neuropathic pain

Neuropathic pain poses a significant challenge due to its complex mechanisms, necessitating specific treatments. In recent decades, significant progress has been made in the clinical research of neuropathic pain, marking a shift from empirical strategies to evidence-based medicine in its management. This review outlines both pharmacological and non-pharmacological interventions. Antidepressants (tricyclic and serotonin-noradrenaline reuptake inhibitors), antiepileptics (gabapentin, pregabalin), and topical agents constitute the main pharmacological treatments. These approaches target peripheral or central mechanisms associated with neuropathic pain. Noninvasive neurostimulation, including transcutaneous electrical nerve stimulation (TENS) and repetitive transcranial magnetic stimulation (rTMS), provides non-pharmacological alternatives. However, challenges persist in effectively targeting existing medications and developing drugs that act on novel targets, necessitating innovative therapeutic strategies.

Efficacy and acceptability of noninvasive brain stimulation for treating posttraumatic stress disorder symptoms: A network meta-analysis of randomized controlled trials.

Despite its high lifetime prevalence rate and the elevated disability caused by posttraumatic stress disorder (PTSD), treatments exhibit modest efficacy. In consideration of the abnormal connectivity between the dorsolateral prefrontal cortex (DLPFC) and amygdala in PTSD, several randomized controlled trials (RCTs) addressing the efficacy of different noninvasive brain stimulation (NIBS) modalities for PTSD management have been undertaken. However, previous RCTs have reported inconsistent results. The current network meta-analysis (NMA) aimed to compare the efficacy and acceptability of various NIBS protocols in PTSD management. We systematically searched ClinicalKey, Cochrane Central Register of Controlled Trials, Embase, ProQuest, PubMed, ScienceDirect, Web of Science, and ClinicalTrials.gov to identify relevant RCTs. The targeted RCTs was those comparing the efficacy of NIBS interventions, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and transcutaneous cervical vagal nerve stimulation, in patients with PTSD. The NMA was conducted using a frequentist model. The primary outcomes were changes in the overall severity of PTSD and acceptability (to be specific, rates of dropouts for any reason). We identified 14 RCTs that enrolled 686 participants. The NMA demonstrated that among the investigated NIBS types, high-frequency rTMS over bilateral DLPFCs was associated with the greatest reduction in overall PTSD severity. Further, in comparison with the sham controls, excitatory stimulation over the right DLPFC with/without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD-related symptoms, including depression and anxiety symptoms, and overall PTSD severity. This NMA demonstrated that excitatory stimulation over the right DLPFC with or without excitatory stimulation over left DLPFC were associated with significant reductions in PTSD-related symptoms. PROSPERO CRD42023391562.

Effects of Transcutaneous Electrical Nerve Stimulation with Taping on Wrist Spasticity, Strength, and Upper Extremity Function in Patients with Stroke: A Randomized Control Trial.

Objective: Six months after the onset of stroke, over 60% of patients experience upper limb dysfunction, with spasticity being a major contributor alongside muscle weakness. This study investigated the effect of transcutaneous electrical nerve stimulation (TENS) with taping on wrist spasticity, strength, and upper extremity function in patients with stroke. Methods: In total, 40 patients with stroke were included and randomly divided into two groups: the TENS + taping (n = 20, age 52.4 ± 9.3 (range: 39 to 70)) and TENS (n = 20, age 53.5 ± 10.8 (range: 39 to 74)) groups. All subjects performed 30 sessions of task-related training, which included 10 min of postural control training and 20 min of task performance. Additionally, all subjects received TENS on the spastic muscle belly for 30 min before task-related training. In the TENS + taping group, taping was additionally applied to the forearm and wrist but not in the TENS group. The Modified Ashworth Scale was used to measure spasticity, and a handheld dynamometer was used to measure muscle strength. The Fugl-Meyer Assessment of Upper Extremity was used to evaluate the functional ability of the upper extremity. Results: In the TENS + taping group, spasticity and upper extremity function were significantly improved as compared to those in the TENS group (p < 0.05). However, no significant difference in muscle strength was observed between the two groups (p > 0.05). Conclusions: This study demonstrated that the combination of TENS and taping for spasticity and function of the upper extremity was more effective in relieving the spasticity than TENS alone. Therefore, we suggest this combination as an additional treatment for spasticity and function of the upper extremity.