This study examined the analgesic effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) on heat pain thresholds in healthy subjects. 48 subjects were randomly assigned to receive either TENS, IFC, or no stimulation for 30 minutes. Heat pain thresholds were measured before, during, and after stimulation. Both TENS and IFC significantly increased heat pain thresholds during stimulation compared to no stimulation. While the effect of TENS did not last long after stimulation, IFC maintained elevated heat pain thresholds for at least 30 minutes following stimulation. The study concluded that both TENS and IFC can effectively reduce heat pain sensitivity in healthy subjects, with IFC having longer-lasting effects.
ZMPCZM016000.11.10 New perspectives in Edema control Via Electrical Stimulationpainezeeman
This document summarizes the historical evidence for using electrical stimulation (ES), particularly high-voltage pulsed current (HVPC), to treat acute edema. It finds that while ES has been commonly used anecdotally for over 200 years, there is little controlled research to support its efficacy. The few early studies that reported benefits of HVPC provided little evidence and no references. More recent animal studies have found no significant effects of HVPC on existing edema. Overall, the document concludes that while HVPC is frequently advocated for edema control, the evidence from controlled studies to support its therapeutic effects is still remarkably weak.
ZMPCZM016000.11.22 effect of the frequency of TENS on the postoperative opio...painezeeman
This study examined the effects of different frequencies of transcutaneous electrical nerve stimulation (TENS) on postoperative opioid requirements. 100 women undergoing gynecological surgery received patient-controlled analgesia and were assigned to receive sham TENS, low-frequency TENS, high-frequency TENS, or mixed-frequency TENS. Mixed-frequency TENS provided the greatest opioid-sparing effect, decreasing morphine requirements by 53% compared to sham TENS. Low and high frequencies also decreased requirements by 32% and 35% respectively. All active TENS groups had shorter PCA therapy duration and less nausea, dizziness, and itching than the sham group.
ZMPCZM016000.11.09 Electrotherpay study summaries for surgeons provided by me...painezeeman
1) Several studies examined the effects of transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) after shoulder and knee surgeries.
2) The studies found that TENS reduced pain levels and analgesic consumption after shoulder surgery compared to placebo. EMS improved quadriceps strength and gait more than voluntary exercise alone after ACL reconstruction.
3) Home interferential current therapy also reduced pain, edema, and improved range of motion more than placebo after ACL reconstruction, meniscectomy, or knee chondroplasty procedures.
ZMPCZM016000.11.23 Electrotherapy for pain managementpainezeeman
This document summarizes research on the use of electrotherapy/electrical stimulation for pain management. It discusses two major theories for how electrotherapy relieves pain through gate control and opiate-mediated control. Research studies cited found electrotherapy effective at reducing pain and improving function for chronic musculoskeletal pain, low back pain, and post-operative knee pain. Meta-analyses showed significant decreases in pain from electrical nerve stimulation and reductions in analgesic consumption when using adequate stimulation parameters.
ZMPCZM016000.11.20 TENS can reduce postoperative analgesic consumption.A meta...painezeeman
TENS can reduce postoperative analgesic consumption according to a meta-analysis of 21 randomized controlled trials. The analysis found that TENS reduced overall analgesic use by 26.5% compared to placebo. For trials using strong, subnoxious TENS at adequate frequencies, analgesic consumption was reduced by 35.5% compared to 4.1% for trials without these optimal parameters. The difference between optimal and non-optimal TENS was statistically significant, indicating TENS can significantly reduce pain medication needs when administered optimally.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
ZMPCZM017000.11.03 Carey Experimentation on brain researchPainezee Specialist
This study investigated the effects of intensive neuromuscular electrical stimulation (NMES) treatment at home over 3 weeks on functional improvements and cortical changes in subjects with chronic stroke. 16 subjects were randomly assigned to either a true NMES treatment group or a sham treatment group. Both groups underwent testing before and after treatment, and the sham group was also tested after crossing over to the true treatment. The true NMES group showed improvements in measures of hand function and strength, while the sham group did not improve initially but did improve after crossing over. Functional MRI revealed increased cortical activation in the ipsilateral somatosensory cortex following true NMES treatment. The findings suggest NMES may stimulate cortical sensory areas to enable improved motor function in subjects
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
ZMPCZM016000.11.10 New perspectives in Edema control Via Electrical Stimulationpainezeeman
This document summarizes the historical evidence for using electrical stimulation (ES), particularly high-voltage pulsed current (HVPC), to treat acute edema. It finds that while ES has been commonly used anecdotally for over 200 years, there is little controlled research to support its efficacy. The few early studies that reported benefits of HVPC provided little evidence and no references. More recent animal studies have found no significant effects of HVPC on existing edema. Overall, the document concludes that while HVPC is frequently advocated for edema control, the evidence from controlled studies to support its therapeutic effects is still remarkably weak.
ZMPCZM016000.11.22 effect of the frequency of TENS on the postoperative opio...painezeeman
This study examined the effects of different frequencies of transcutaneous electrical nerve stimulation (TENS) on postoperative opioid requirements. 100 women undergoing gynecological surgery received patient-controlled analgesia and were assigned to receive sham TENS, low-frequency TENS, high-frequency TENS, or mixed-frequency TENS. Mixed-frequency TENS provided the greatest opioid-sparing effect, decreasing morphine requirements by 53% compared to sham TENS. Low and high frequencies also decreased requirements by 32% and 35% respectively. All active TENS groups had shorter PCA therapy duration and less nausea, dizziness, and itching than the sham group.
ZMPCZM016000.11.09 Electrotherpay study summaries for surgeons provided by me...painezeeman
1) Several studies examined the effects of transcutaneous electrical nerve stimulation (TENS) and electrical muscle stimulation (EMS) after shoulder and knee surgeries.
2) The studies found that TENS reduced pain levels and analgesic consumption after shoulder surgery compared to placebo. EMS improved quadriceps strength and gait more than voluntary exercise alone after ACL reconstruction.
3) Home interferential current therapy also reduced pain, edema, and improved range of motion more than placebo after ACL reconstruction, meniscectomy, or knee chondroplasty procedures.
ZMPCZM016000.11.23 Electrotherapy for pain managementpainezeeman
This document summarizes research on the use of electrotherapy/electrical stimulation for pain management. It discusses two major theories for how electrotherapy relieves pain through gate control and opiate-mediated control. Research studies cited found electrotherapy effective at reducing pain and improving function for chronic musculoskeletal pain, low back pain, and post-operative knee pain. Meta-analyses showed significant decreases in pain from electrical nerve stimulation and reductions in analgesic consumption when using adequate stimulation parameters.
ZMPCZM016000.11.20 TENS can reduce postoperative analgesic consumption.A meta...painezeeman
TENS can reduce postoperative analgesic consumption according to a meta-analysis of 21 randomized controlled trials. The analysis found that TENS reduced overall analgesic use by 26.5% compared to placebo. For trials using strong, subnoxious TENS at adequate frequencies, analgesic consumption was reduced by 35.5% compared to 4.1% for trials without these optimal parameters. The difference between optimal and non-optimal TENS was statistically significant, indicating TENS can significantly reduce pain medication needs when administered optimally.
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments three times per week for four weeks or to a control group that received no treatment. Outcomes were assessed at baseline and at 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding of the assessor and participants to group assignment. Four weeks of NMES may have been insufficient to induce gains in this population and future research is needed to examine longer or more
ZMPCZM017000.11.03 Carey Experimentation on brain researchPainezee Specialist
This study investigated the effects of intensive neuromuscular electrical stimulation (NMES) treatment at home over 3 weeks on functional improvements and cortical changes in subjects with chronic stroke. 16 subjects were randomly assigned to either a true NMES treatment group or a sham treatment group. Both groups underwent testing before and after treatment, and the sham group was also tested after crossing over to the true treatment. The true NMES group showed improvements in measures of hand function and strength, while the sham group did not improve initially but did improve after crossing over. Functional MRI revealed increased cortical activation in the ipsilateral somatosensory cortex following true NMES treatment. The findings suggest NMES may stimulate cortical sensory areas to enable improved motor function in subjects
This study investigated the efficacy of pulsed electromagnetic field therapy (PEMF) in reducing delayed onset muscle soreness (DOMS) in marathon runners. A double-blind randomized controlled trial assigned 133 marathon runners to either an active PEMF device or placebo device to use for 20 minutes, 4 times per day for 5 days after a marathon. The primary outcome was thigh pain assessed using a visual analog scale during squats. Subjects using the active PEMF device had significantly lower pain scores compared to the placebo group, indicating PEMF reduced DOMS in marathon runners.
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
ZMPCZM017000.11.11 Home based EMG Triggered stimulation in chronic strokepainezeeman
This study investigated the feasibility and efficacy of home-based electromyography-triggered neuromuscular stimulation (ETMS) for chronic stroke patients with limited wrist extension. Twelve chronic stroke patients were randomly assigned to receive either 8 weeks of ETMS followed by 8 weeks of home exercises, or vice versa. Outcome measures assessed wrist extension range of motion and impairment scales. Results showed that both groups increased active wrist extension by 21 degrees after ETMS, but no significant changes on impairment scales. The study concluded that home-based ETMS is feasible and can increase wrist extension, but does not significantly impact impairment scales.
ZMPCZM016000.10.01 Nexwave clinical presentaion from PainezeePainezee Specialist
This document provides an overview of electrotherapy modalities for pain management using the NexWave device. It discusses the basics of how electrical impulses work to reduce pain through gate control theory and endorphin release. Three main modalities are covered: TENS, IFC, and NMES. The document reviews indications, electrode placement, programming and operation of the NexWave device for each modality. It also discusses supporting research, marketing materials and distribution to physicians for pain management using electrotherapy.
This randomized, double-blind pilot study examined the effects of pulsed electromagnetic field (PEMF) therapy on pain in patients with early knee osteoarthritis. 34 patients were randomly assigned to either an active PEMF device group (n=15) or a sham device group (n=19). The PEMF signal was designed to modulate the calcium/calmodulin dependent nitric oxide signaling pathway. Results showed a 50% reduction in pain scores from baseline in the active group starting on day 1 and persisting to day 42, while no significant reduction was seen in the sham group. The overall decrease in pain was nearly threefold greater in the active group. The rapid and sustained pain relief seen with PEMF therapy suggests it may reduce inflammation
The document discusses varying the frequency and intensity of transcutaneous electrical nerve stimulation (TENS) for treating acute and chronic pain. It summarizes several studies that investigated:
1) The effectiveness of high vs low frequency TENS for reducing hyperalgesia and whether activation of cutaneous or deep tissue afferents is responsible for TENS analgesia.
2) The impact of varying TENS frequency, intensity, and pulse duration on primary and secondary hyperalgesia in an animal model of inflammation.
3) The short and long-term effects of high frequency TENS on motor cortex excitability in humans.
4) The effectiveness of high vs low frequency TENS for reversing hyper
This study investigated nerve excitability changes in patients with fibromyalgia. The following key findings were reported:
1) Patients with fibromyalgia showed increased superexcitability in sensory nerve fibers compared to healthy controls, indicating heightened sensory nerve responsiveness.
2) Subexcitability in sensory nerve fibers correlated negatively with fibromyalgia impact questionnaire scores, suggesting increased nerve subexcitability is associated with greater fibromyalgia severity.
3) Computer modeling suggested the sensory nerve excitability pattern in fibromyalgia patients was best explained by increased potassium conductance, attributed to dysfunction of paranodal fast potassium channels known to be involved in pain generation.
Meta analysis of clinical efficacy of pulsed radio frequencyPainezee Specialist
This meta-analysis reviewed 25 controlled clinical trials involving 1332 patients to evaluate the efficacy of pulsed radio frequency energy (PRFE) therapy for postoperative pain and edema, nonpostoperative pain and edema, and wound healing. A vote-counting method found more positive outcomes than neutral or negative outcomes for each clinical application. A statistical combination of P-values also found statistically significant improvements in pain, edema reduction, and wound healing outcomes. The analysis provides strong statistical evidence that PRFE therapy is an effective treatment for postoperative and nonpostoperative pain and edema as well as for wound healing applications.
1) IFT and TENS are electrotherapy modalities used to reduce pain. IFT uses two medium frequencies modulated at a low frequency to penetrate deeper tissue more comfortably than low-frequency TENS.
2) Studies have found IFT effective at increasing pain thresholds and cutaneous blood flow. However, results are mixed on whether any frequency is most effective. Studies also found TENS and IFT similarly effective at reducing heat pain.
3) Overall, the studies found IFT and TENS can increase pain thresholds, but effects depend on stimulation parameters and no modality consistently outperformed others for all outcomes. Both techniques remain useful options for pain management.
Physical activity in the treatment of fibromyalgia (1)DanielaClarosV
This document summarizes research on the use of physical activity in treating fibromyalgia. It finds that international treatment guidelines highly recommend adapted physical activity combined with patient education. Several reviews have found strong evidence that supervised aerobic and resistance training programs can significantly reduce pain intensity and improve quality of life and physical/psychological functioning for women with fibromyalgia. The document discusses the low physical conditioning of fibromyalgia patients and various studies showing benefits of aerobic exercise, resistance training, stretching, aquatic exercise, and mixed exercise programs on outcomes like quality of life and pain. The biological mechanisms through which exercise may help, such as effects on the nociceptive and neuroendocrine systems, are also summarized.
Evidence based radial shock wave therapyCORR MEDICAL
PEDRro: Physiotherapy Evidence Database. Radial Shockwave Therapy.
+info: http://ondaschoque.net
CORR MEDICAL. Expertos en ondas de choque ESWL, ESWT y rESW. Distribuidores exclusivos de los constructores líderes: Electro Medical Sytems y JenaMedTech.
Acupuncture is one of the oldest types of therapy known to us for about five thousand years. It originated in Asia, specifically in China, was developed further and constituted a very essential part of medicine in that part of the world. In the West, acupuncture was virtually unknown until the year 1972. Professor Bischko was able to prove its mode of action using scientifically recognized methods of Western medicine.
Electro-acupuncture is already used on a word-wide scale at present, but has found only limited application in auricular acupuncture, due to the currently relatively large sized equipment. For this reason, a miniature form of electro- acupuncture has been developed, in order to permit carrying out long term auricular acupuncture. The main component of the device is a micro controller (in further sequence a microchip), which allows continuous stimulation in conjunction with an integrated acupuncture needle.
Postoperative pain is a major concern for patients and doctors. This preliminary study investigated the use of a wearable pulsed radiofrequency energy (PRFE) device to control postoperative pain in 18 women undergoing breast augmentation surgery. Patients were randomly assigned to receive either an active or placebo PRFE device. Those receiving the active device experienced significantly lower pain scores over 7 days as measured by a visual analog scale. They also took fewer narcotic pain medications than those receiving the placebo. The findings suggest PRFE therapy is an effective non-drug method for controlling postoperative pain.
Application of Pstim in Clinical Practice MaxiMedRx
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
Reduced Short- and Long-Latency Afferent Inhibition Following Acute Muscle Pa...Antonio Martinez
Corticomotor output is reduced in re-
sponse to acute muscle pain, yet the mechanisms
that underpin this effect remain unclear. Here the au-
thors investigate the effect of acute muscle pain on
short-latency afferent inhibition, long-latency afferent
inhibition, and long-interval intra-cortical inhibition to
determine whether these mechanisms could plausibly
contribute to reduced motor output in pain.
1) A double-blind randomized controlled study evaluated a wearable pulsed radiofrequency electromagnetic field (PRFE) device for treating plantar fasciitis.
2) 70 subjects with plantar fasciitis were randomly assigned either an active or placebo PRFE device to wear overnight for 7 days.
3) The active PRFE device showed a progressive 40% decline in morning heel pain over 7 days, significantly greater than the 7% decline in the control group, demonstrating PRFE's potential as a drug-free noninvasive treatment for reducing plantar fasciitis pain.
Objective: Tennis elbow is an inflammatory condition of the common extensor origin over the lateral epicondyle. This condition does not affect tennis players only. It often follows an injury or sudden contraction of the common extensor origin.There is many treatments and approaches towards Tennis elbow but physiotherapy is the best modern conservative treatment. The aim of this study is to evaluate the effectiveness of movement with mobilization in reducing pain and increasing strength in patients with chronic lateral epicondylitis. Design and setting: A randomized controlled study design was used to examine the differences between conventional physical therapy and physical therapy with manual mobilization approach for study duration of 15 days. Subjects: Twelve subjects of both male and female gender were divided into 2 groups. Experimental group treated with ultrasound therapy, mobilization and progressive resisted exercises. Control group treated with ultrasound therapy and progressive resisted exercises only the results were analyzed. The procedure was done in Physiotherapy Department at Masterskill college of Nursing and health. Outcome Measurement: Two outcome measures were used. NPRS for the measurement of severity of pain and various weighted sand bags (0.25 kg to 2kg) were used to measure the strength. Results: The data shows a significant difference in the post test values of pain and strength between experimental group and control group. Experimental group shows much decrease in pain and increase in strength than the control group. Conclusion: The study concludes that the manual mobilization with movement along with ultrasound therapy and progressive resisted exercises is effective in reducing pain and increasing strength than that of progressive resisted exercise along with ultra sound therapy in adults with chronic lateral epicondylitis.
Relief of urinary urgency, hesitancy, and male pelvic pain with pulsed radiof...Jason Attaman
This document summarizes a case report of a 86-year-old man who underwent pulsed radiofrequency ablation (RFA) of the pudendal nerve to treat urinary urgency, hesitancy, and pelvic pain. The patient had a 30-year history of urinary symptoms and had tried various medications and procedures without success. After undergoing pulsed RFA of the pudendal nerve, the patient reported marked improvement in his pelvic pain and a significant reduction in his urinary symptoms. The summary concludes that pudendal nerve block with pulsed RFA may be an effective treatment for pelvic pain and urinary symptoms.
ZMPCZM016000.11.08 Applications of TENS in the management of Patients with painpainezeeman
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
ZMPCZM016000.11.04 A clinical trail of NMES in improving quadraceps muscle st...painezeeman
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments 3 times per week for 4 weeks or to a control group that received no treatment. Outcomes were assessed at baseline and 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding, suggesting further research is needed to determine an effective dosage of NMES for this population.
This certificate certifies that Zynex Medical, Inc. has been audited and its quality system for producing electro-therapy devices has been found to conform with the relevant EU directives. The certificate covers Zynex Medical's NexWave electro-therapy device. The audit was conducted on December 7, 2011 and the certificate is valid until January 1, 2017, allowing Zynex Medical to affix the CE marking to conforming products.
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
ZMPCZM017000.11.11 Home based EMG Triggered stimulation in chronic strokepainezeeman
This study investigated the feasibility and efficacy of home-based electromyography-triggered neuromuscular stimulation (ETMS) for chronic stroke patients with limited wrist extension. Twelve chronic stroke patients were randomly assigned to receive either 8 weeks of ETMS followed by 8 weeks of home exercises, or vice versa. Outcome measures assessed wrist extension range of motion and impairment scales. Results showed that both groups increased active wrist extension by 21 degrees after ETMS, but no significant changes on impairment scales. The study concluded that home-based ETMS is feasible and can increase wrist extension, but does not significantly impact impairment scales.
ZMPCZM016000.10.01 Nexwave clinical presentaion from PainezeePainezee Specialist
This document provides an overview of electrotherapy modalities for pain management using the NexWave device. It discusses the basics of how electrical impulses work to reduce pain through gate control theory and endorphin release. Three main modalities are covered: TENS, IFC, and NMES. The document reviews indications, electrode placement, programming and operation of the NexWave device for each modality. It also discusses supporting research, marketing materials and distribution to physicians for pain management using electrotherapy.
This randomized, double-blind pilot study examined the effects of pulsed electromagnetic field (PEMF) therapy on pain in patients with early knee osteoarthritis. 34 patients were randomly assigned to either an active PEMF device group (n=15) or a sham device group (n=19). The PEMF signal was designed to modulate the calcium/calmodulin dependent nitric oxide signaling pathway. Results showed a 50% reduction in pain scores from baseline in the active group starting on day 1 and persisting to day 42, while no significant reduction was seen in the sham group. The overall decrease in pain was nearly threefold greater in the active group. The rapid and sustained pain relief seen with PEMF therapy suggests it may reduce inflammation
The document discusses varying the frequency and intensity of transcutaneous electrical nerve stimulation (TENS) for treating acute and chronic pain. It summarizes several studies that investigated:
1) The effectiveness of high vs low frequency TENS for reducing hyperalgesia and whether activation of cutaneous or deep tissue afferents is responsible for TENS analgesia.
2) The impact of varying TENS frequency, intensity, and pulse duration on primary and secondary hyperalgesia in an animal model of inflammation.
3) The short and long-term effects of high frequency TENS on motor cortex excitability in humans.
4) The effectiveness of high vs low frequency TENS for reversing hyper
This study investigated nerve excitability changes in patients with fibromyalgia. The following key findings were reported:
1) Patients with fibromyalgia showed increased superexcitability in sensory nerve fibers compared to healthy controls, indicating heightened sensory nerve responsiveness.
2) Subexcitability in sensory nerve fibers correlated negatively with fibromyalgia impact questionnaire scores, suggesting increased nerve subexcitability is associated with greater fibromyalgia severity.
3) Computer modeling suggested the sensory nerve excitability pattern in fibromyalgia patients was best explained by increased potassium conductance, attributed to dysfunction of paranodal fast potassium channels known to be involved in pain generation.
Meta analysis of clinical efficacy of pulsed radio frequencyPainezee Specialist
This meta-analysis reviewed 25 controlled clinical trials involving 1332 patients to evaluate the efficacy of pulsed radio frequency energy (PRFE) therapy for postoperative pain and edema, nonpostoperative pain and edema, and wound healing. A vote-counting method found more positive outcomes than neutral or negative outcomes for each clinical application. A statistical combination of P-values also found statistically significant improvements in pain, edema reduction, and wound healing outcomes. The analysis provides strong statistical evidence that PRFE therapy is an effective treatment for postoperative and nonpostoperative pain and edema as well as for wound healing applications.
1) IFT and TENS are electrotherapy modalities used to reduce pain. IFT uses two medium frequencies modulated at a low frequency to penetrate deeper tissue more comfortably than low-frequency TENS.
2) Studies have found IFT effective at increasing pain thresholds and cutaneous blood flow. However, results are mixed on whether any frequency is most effective. Studies also found TENS and IFT similarly effective at reducing heat pain.
3) Overall, the studies found IFT and TENS can increase pain thresholds, but effects depend on stimulation parameters and no modality consistently outperformed others for all outcomes. Both techniques remain useful options for pain management.
Physical activity in the treatment of fibromyalgia (1)DanielaClarosV
This document summarizes research on the use of physical activity in treating fibromyalgia. It finds that international treatment guidelines highly recommend adapted physical activity combined with patient education. Several reviews have found strong evidence that supervised aerobic and resistance training programs can significantly reduce pain intensity and improve quality of life and physical/psychological functioning for women with fibromyalgia. The document discusses the low physical conditioning of fibromyalgia patients and various studies showing benefits of aerobic exercise, resistance training, stretching, aquatic exercise, and mixed exercise programs on outcomes like quality of life and pain. The biological mechanisms through which exercise may help, such as effects on the nociceptive and neuroendocrine systems, are also summarized.
Evidence based radial shock wave therapyCORR MEDICAL
PEDRro: Physiotherapy Evidence Database. Radial Shockwave Therapy.
+info: http://ondaschoque.net
CORR MEDICAL. Expertos en ondas de choque ESWL, ESWT y rESW. Distribuidores exclusivos de los constructores líderes: Electro Medical Sytems y JenaMedTech.
Acupuncture is one of the oldest types of therapy known to us for about five thousand years. It originated in Asia, specifically in China, was developed further and constituted a very essential part of medicine in that part of the world. In the West, acupuncture was virtually unknown until the year 1972. Professor Bischko was able to prove its mode of action using scientifically recognized methods of Western medicine.
Electro-acupuncture is already used on a word-wide scale at present, but has found only limited application in auricular acupuncture, due to the currently relatively large sized equipment. For this reason, a miniature form of electro- acupuncture has been developed, in order to permit carrying out long term auricular acupuncture. The main component of the device is a micro controller (in further sequence a microchip), which allows continuous stimulation in conjunction with an integrated acupuncture needle.
Postoperative pain is a major concern for patients and doctors. This preliminary study investigated the use of a wearable pulsed radiofrequency energy (PRFE) device to control postoperative pain in 18 women undergoing breast augmentation surgery. Patients were randomly assigned to receive either an active or placebo PRFE device. Those receiving the active device experienced significantly lower pain scores over 7 days as measured by a visual analog scale. They also took fewer narcotic pain medications than those receiving the placebo. The findings suggest PRFE therapy is an effective non-drug method for controlling postoperative pain.
Application of Pstim in Clinical Practice MaxiMedRx
The P-Stim and ANSiStim™ miniaturized device is designed to administer auricular point stimulation treatment over several days. The ear provides numerous points for stimulation within a small area. Stimulation is performed by electrical pulses emitted through strategically positioned needles. The ANSiscope device monitors the pain condition of the patient before, during and after the treatment.
The P-Stim and ANSiStim™ point stimulation therapy is mainly used to treat pain. Use of the device is recommended for pre-operative, intra-operative and post-operative pain therapy as well as for the treatment of chronic pain. DyAnsys is researching the possibilities of using this concept for the treatment of depression, addiction and allergy.
P-Stim and ANSiStim™ therapy allows continuous point stimulation over a period of several days while offering the patient a high degree of comfort and mobility. Use of the P-Stim and ANSiStim™ therapy provides advantages over drug therapy by minimizing possible side-effects caused by pain medications (i.e. opioid). In most cases, the patient continues to lead a normal life without side effects or any loss of quality of life.
Reduced Short- and Long-Latency Afferent Inhibition Following Acute Muscle Pa...Antonio Martinez
Corticomotor output is reduced in re-
sponse to acute muscle pain, yet the mechanisms
that underpin this effect remain unclear. Here the au-
thors investigate the effect of acute muscle pain on
short-latency afferent inhibition, long-latency afferent
inhibition, and long-interval intra-cortical inhibition to
determine whether these mechanisms could plausibly
contribute to reduced motor output in pain.
1) A double-blind randomized controlled study evaluated a wearable pulsed radiofrequency electromagnetic field (PRFE) device for treating plantar fasciitis.
2) 70 subjects with plantar fasciitis were randomly assigned either an active or placebo PRFE device to wear overnight for 7 days.
3) The active PRFE device showed a progressive 40% decline in morning heel pain over 7 days, significantly greater than the 7% decline in the control group, demonstrating PRFE's potential as a drug-free noninvasive treatment for reducing plantar fasciitis pain.
Objective: Tennis elbow is an inflammatory condition of the common extensor origin over the lateral epicondyle. This condition does not affect tennis players only. It often follows an injury or sudden contraction of the common extensor origin.There is many treatments and approaches towards Tennis elbow but physiotherapy is the best modern conservative treatment. The aim of this study is to evaluate the effectiveness of movement with mobilization in reducing pain and increasing strength in patients with chronic lateral epicondylitis. Design and setting: A randomized controlled study design was used to examine the differences between conventional physical therapy and physical therapy with manual mobilization approach for study duration of 15 days. Subjects: Twelve subjects of both male and female gender were divided into 2 groups. Experimental group treated with ultrasound therapy, mobilization and progressive resisted exercises. Control group treated with ultrasound therapy and progressive resisted exercises only the results were analyzed. The procedure was done in Physiotherapy Department at Masterskill college of Nursing and health. Outcome Measurement: Two outcome measures were used. NPRS for the measurement of severity of pain and various weighted sand bags (0.25 kg to 2kg) were used to measure the strength. Results: The data shows a significant difference in the post test values of pain and strength between experimental group and control group. Experimental group shows much decrease in pain and increase in strength than the control group. Conclusion: The study concludes that the manual mobilization with movement along with ultrasound therapy and progressive resisted exercises is effective in reducing pain and increasing strength than that of progressive resisted exercise along with ultra sound therapy in adults with chronic lateral epicondylitis.
Relief of urinary urgency, hesitancy, and male pelvic pain with pulsed radiof...Jason Attaman
This document summarizes a case report of a 86-year-old man who underwent pulsed radiofrequency ablation (RFA) of the pudendal nerve to treat urinary urgency, hesitancy, and pelvic pain. The patient had a 30-year history of urinary symptoms and had tried various medications and procedures without success. After undergoing pulsed RFA of the pudendal nerve, the patient reported marked improvement in his pelvic pain and a significant reduction in his urinary symptoms. The summary concludes that pudendal nerve block with pulsed RFA may be an effective treatment for pelvic pain and urinary symptoms.
ZMPCZM016000.11.08 Applications of TENS in the management of Patients with painpainezeeman
This article reviews recent literature on the application of transcutaneous electrical nerve stimulation (TENS) for pain management. Several studies have found TENS to be effective for acute postoperative pain, reducing medication needs and facilitating earlier recovery. TENS placed near surgical incisions reduced pain and medication requirements after procedures like laparotomy, cholecystectomy, and laminectomy. TENS may also benefit rehabilitation after knee surgery by reducing pain and narcotic use, allowing for earlier quadriceps strengthening and range of motion. While specific stimulation settings do not seem to impact outcomes, proper electrode placement is important. Overall, TENS is an effective non-pharmacological option for acute pain that facilitates recovery after surgery and injury.
ZMPCZM016000.11.04 A clinical trail of NMES in improving quadraceps muscle st...painezeeman
This clinical trial investigated whether neuromuscular electrical stimulation (NMES) could improve quadriceps muscle strength and activation in women with mild to moderate osteoarthritis of the knee. Thirty women were randomly assigned to either receive NMES treatments 3 times per week for 4 weeks or to a control group that received no treatment. Outcomes were assessed at baseline and 5 and 16 weeks post-enrollment and found no improvements in muscle strength or activation in the NMES group compared to controls. The study was limited by a small sample size and lack of blinding, suggesting further research is needed to determine an effective dosage of NMES for this population.
This certificate certifies that Zynex Medical, Inc. has been audited and its quality system for producing electro-therapy devices has been found to conform with the relevant EU directives. The certificate covers Zynex Medical's NexWave electro-therapy device. The audit was conducted on December 7, 2011 and the certificate is valid until January 1, 2017, allowing Zynex Medical to affix the CE marking to conforming products.
ZMPCZM016000.13.03 Certificate of compliancepainezeeman
The Certificate of Compliance certifies that the Zynex Medical NexWave TENS unit was tested and found to comply with IEC 60601-1 and IEC 60601-2-10 standards. The NexWave is a portable TENS unit that can be powered by an internal battery or external power supply and has two independent stimulation channels to apply electrical stimulation to skin sites via electrode pads. Compliance testing was performed by Compliance Integrity Services and the NexWave was
ZMPCZM016000.10.02 Nexwave Training for Hyderabad, India.Painezee Specialist
The NexWave device provides electrotherapy treatment options through a user friendly interface that allows patients to control their treatment. It offers IFC, TENS, and NMES modalities across 9 preprogrammed modes that can be easily switched between. The large display interface allows monitoring of treatment parameters and settings can be modified through simple button presses.
This document declares that the NexWave Combo Muscle Stimulator and similar products manufactured for other distributors meet the essential health and safety requirements of the European Community. The manufacturer, Zynex Medical, Inc., used conformity assessment procedures and standards including ISO 13485 for quality management, IEC 60601 for electrical safety of medical equipment, and EN 1041 for information supplied by manufacturers. Thomas Sandgaard, President and CEO of Zynex Medical, Inc., signed the declaration on November 18, 2011.
This document contains information about dermatome charts, peripheral nerve charts, and motor point locations for electrostimulation therapy. The dermatome charts show the cutaneous nerve innervation patterns for the front, back, and foot. The peripheral nerve charts display the branches of the cervical, brachial, lumbar, and sacral plexuses. The motor point sections provide diagrams of the anterior and posterior muscle motor points for the trunk, upper extremities, and lower extremities.
A NALYSIS OF P AIN H EMODYNAMIC R ESPONSE U SING N EAR -I NFRARED S PECTROSCOPYijma
Despite recent advances in brain research, understa
nding the various signals for pain and pain intensi
ties
in the brain cortex is still a complex task due to
temporal and spatial variations of brain haemodynam
ics.
In this paper we have investigated pain based on ce
rebral hemodynamics via near-infrared spectroscopy
(NIRS). This study presents a pain stimulation expe
riment that uses three acupuncture manipulation
techniques to safely induce pain in healthy subject
s. Acupuncture pain response was presented and
Haemodynamic pain signal analysis showed the presence of dominant channels and their relationship
among surrounding channels, which contribute the fu
rther pain research area.
EFFECTS OF ELECTROTHERAPY VS MYOFASCIAL RELEASE ON TRIGGER POINT.pptxsammer
This study compared the effectiveness of electrotherapy versus myofascial release on trigger points. A review of 25 research articles found that while electrotherapy can effectively reduce pain in the short term, myofascial release is one of the best therapies for treating and resolving trigger points. Specifically, myofascial release decreases pain through endorphin release and increased blood flow and tissue nutrition, while also reducing muscle tension. However, the study concluded that both electrotherapy and myofascial release showed beneficial effects in reducing pain and increasing range of motion, with no significant differences found between the two treatment methods.
A Comparison of the Analgesic Efficacy of medium-frequency alternating Curren...ACN
This study compared the analgesic efficacy of burst-modulated medium-frequency alternating current (BMAC) and transcutaneous electrical nerve stimulation (TENS) using an experimental cold pain model. Twenty healthy subjects received both BMAC (4-kHz AC applied in 4-millisecond bursts at 50 Hz) and TENS (125-microsecond phase duration applied at a frequency of 50 Hz) on separate occasions. The results showed that both interventions significantly increased cold pain thresholds compared to baseline, and there was no significant difference between the interventions. Therefore, BMAC was as effective as TENS in increasing cold pain thresholds in healthy subjects.
This document summarizes an experiment that examined the effects of direct and indirect stimulation on a frog gastrocnemius muscle. It found that:
1) Direct stimulation of the muscle required a higher threshold voltage than indirect stimulation of the nerve to induce contraction.
2) Onset and peak latencies were shorter when stimulating the muscle directly compared to stimulating the nerve indirectly.
3) Both direct and indirect prolonged stimulation induced muscle fatigue, with an 83-85% reduction in contractile force over 30 seconds.
The document discusses electroacupuncture (EA), which applies small electrical currents to acupuncture needles inserted at specific points. It provides an overview of the history, mechanisms, efficacy, and safety of EA for pain management based on clinical studies and research findings. EA is shown to be an effective treatment for various types of pain, including chronic pain, musculoskeletal pain, and neuropathic pain.
Non-uniform electromyographic activity during fatigue and recovery of the vas...Nosrat hedayatpour
The aim of the study was to investigate EMG signal features
during fatigue and recovery at three locations of the vastus
medialis and lateralis muscles.
INTRODUCTION
HISTORY
EPIDEMIOLOGY
DEFINITIONS OF PAIN
BENEFITS OF PAIN
NOCICEPTION
PAIN RECEPTORS
THEORIES OF PAIN
CHARACTERISTICS OF PAIN
PAIN PATHWAY
MECHANISM OF PAIN
PAIN ASSESSMENT
APPLIED ASPECTS
CONCLUSION
REFERENCES
This article reviews recent literature on the use of transcutaneous electrical nerve stimulation (TENS) to manage acute and chronic pain. For acute pain, TENS has been shown to reduce postoperative pain and medication use when electrodes are placed near incisions and used continuously for 48-72 hours. Studies of TENS for acute dental pain and labor also found it provided pain relief. Treatment outcomes are evaluated using subjective pain ratings and objective measures like pulmonary function and range of motion. While TENS provides pain relief for many acute conditions, its effectiveness for chronic pain varies more between individuals. More research is needed to determine which chronic pain patients respond best to TENS.
This study compared the ability of two ultrasound units, the Omnisound 3000 and the Forte 400 Combo, to increase tissue temperature at a depth of 1.2 cm. Researchers administered 10 minutes of continuous ultrasound at 3 MHz and 1 W/cm2 to the calf muscles of 10 healthy subjects. Tissue temperature was monitored continuously. The Omnisound 3000 produced a significantly greater increase in temperature, raising it by 5.81°C compared to 3.85°C for the Forte 400 Combo. The Omnisound 3000 was more effective at penetrating tissue and increasing temperature. However, the Forte 400 Combo is less expensive for clinicians.
This study aimed to investigate the neuromotor effects of transverse friction massage (TFM) on the quadriceps femoris tendon using surface electromyography, force sensors, and ultrafast ultrasound. Fourteen healthy males received TFM on their quadriceps tendon while fifteen controls rested. Signals were recorded before and after TFM/resting to analyze time delays related to excitation-contraction coupling, force transmission, and electromechanical delay during voluntary contractions. Results showed TFM increased the time of excitation-contraction coupling and electromechanical delay, while decreasing time of force transmission, suggesting TFM influences neuro-motor mechanisms and changes muscle and tendon stiffness. The study provides insight into how TFM applied
1) The study examined the mechanisms underlying pain in patients with joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility type (JHS/EDS-HT).
2) Clinical exams, questionnaires, and sensory testing found no evidence of somatosensory nervous system damage but did find signs of central sensitization such as lowered pain thresholds and increased wind-up ratio.
3) The results suggest that rather than neuropathic pain, the pain experienced by patients with JHS/EDS-HT is caused by central sensitization, sharing mechanisms with fibromyalgia.
1) The study examined the mechanisms underlying pain in patients with joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility type (JHS/EDS-HT).
2) Clinical exams, questionnaires, and sensory testing found no evidence of somatosensory nervous system damage but did find signs of central sensitization such as lowered pain thresholds and increased wind-up ratio.
3) The results suggest that rather than neuropathic pain, the pain experienced by patients with JHS/EDS-HT is caused by central sensitization, sharing mechanisms with fibromyalgia.
This document presents 4 case reports on using medical shockwave therapy to treat complex and neuropathic pain syndromes in the lower extremities. The patients received 3 treatments of low-intensity shockwaves over 3 weeks and experienced reductions in pain levels and improvements in function based on questionnaires. The results provide preliminary evidence that shockwave therapy may help treat neuropathic and complex pain conditions and warrant further investigation.
This document summarizes key findings from neuroimaging studies on pain processing in the brain. A meta-analysis of 122 pain studies found activation in brain regions involved in sensory and affective pain processing, including the thalamus, insula, and anterior cingulate cortex. Studies also show cortical thickness in pain regions correlates with pain modulation abilities and pain catastrophizing traits. Brain plasticity underlies changes from chronic pain, memory of pain, and phantom limb pain.
Electrotherapy for osteoarthritis, frozen shoulder and low back pain.kalpesh hospital
This document discusses various electrotherapeutic approaches for treating osteoarthritis (OA) of the knee, including their mechanisms and effectiveness. It summarizes several studies on:
1. Shortwave diathermy (SWD), which uses heat to reduce pain and increase mobility in OA patients. Studies found SWD effective for decreasing knee pain over 15-9 treatment sessions.
2. Ultrasound, which uses sound waves to increase blood flow and reduce inflammation/pain in OA. Pulsed ultrasound may be more effective than continuous ultrasound.
3. Neuromuscular electrical stimulation (NMES), which strengthens muscles in OA patients. NMES reduced weakness and improved function in OA patients over
ESP block - future direction and remaining questionsAmit Pawa
This Talk was delivered by Dr Pawa on 5th June 2021 as part of the ISURA 2021 hybrid conference held in Toronto.
The Future Direction of this block and remaining questions to be answered are covered here
This document provides information on transcutaneous electrical nerve stimulation (TENS), interferential therapy (IFT), and paraffin wax bath therapy. It describes how each therapy works, including parameters and modes. It outlines indications and contraindications. For TENS, it discusses waveform, frequency, pulse width, amplitude and types (conventional, acupuncture-like, brief intense, burst mode). For IFT, it explains the interference of two medium frequencies. For paraffin wax bath, it describes the unit, application methods, and physiological effects of increased heat and circulation.
19 rbeb relationship between peak and mean amplitudes v29n2Nathanael Amparo
The document describes a study that investigated the relationship between peak and mean amplitudes of stimulator output voltage during functional electrical stimulation (FES) of the knee. Ten healthy volunteers and ten spinal cord injured volunteers participated. Four different FES profiles were tested to determine which produced the lowest peak and mean amplitudes needed to extend the knee from 90 to 40 degrees. The results showed that higher amplitudes were required for spinal cord injured volunteers compared to healthy volunteers. The profile with 100 microsecond pulses at 50 Hz produced the lowest mean amplitudes for both groups.
This study investigated the effects of cryotherapy (cold therapy) on nerve conduction velocity (NCV), pain threshold (PTH), and pain tolerance (PTO) in the ankles of 23 male athletes. Cryotherapy was applied to one ankle (experimental ankle) while the other ankle served as a control. NCV, PTH, and PTO were measured at the experimental ankle both before and during cryotherapy application when skin temperatures reached 15°C and 10°C. The control ankle was only measured and not treated with cryotherapy. The results showed that cryotherapy significantly reduced NCV in the experimental ankle as skin temperature decreased. Cryotherapy also significantly increased both PTH and PTO at both the experimental and control ank
This document summarizes a chapter about energy medicine. It discusses how energy medicine treats disturbances in the human biofield known as chi or prana. It defines two categories of energy medicine - veritable energy medicine which uses mechanical vibration and electromagnetic radiation, and putative energy medicine which is based on concepts not yet measurable. It provides examples of veritable energy medicine treatments like pulsed electromagnetic field therapy and discusses research showing their anti-inflammatory and healing effects for various conditions like arthritis, wounds, and pain.
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This certificate certifies that Zynex Medical, Inc. has been audited and its quality system for producing electro-therapy devices has been found to conform with the relevant EU directives. The certificate covers Zynex Medical's NexWave electro-therapy device. The audit was conducted on December 7, 2011 and the certificate is valid until January 1, 2017, allowing Zynex Medical to affix the CE marking to conforming products.
ZMPCZM019000.11.04 Evidenced based guidelines for Migrane Headache : Behaviou...painezeeman
The document summarizes evidence from studies on behavioral and physical treatments for migraine headaches. It finds that relaxation training, thermal biofeedback plus relaxation training, EMG biofeedback therapy, and cognitive-behavioral therapy led to statistically significant improvements in headache frequency and severity, with effect sizes ranging from moderate to large. Combining cognitive-behavioral therapy with thermal biofeedback produced more modest improvements. Studies of acupuncture for migraines showed mixed results, with some finding it more effective than sham treatments and others finding no difference compared to sham interventions.
ZMPCZM019000.11.03 EMG based evaluation & therapy concept for pelvic floor Dy...painezeeman
(1) EMG is used to directly measure pelvic floor muscle function and innervation for evaluating and treating dysfunctions like incontinence. (2) A 4-channel EMG system measures the pelvic floor and surrounding muscles during standardized tests to analyze coordination and identify issues. (3) Biofeedback training then focuses on re-educating the pelvic floor muscle through isolated activation exercises and integrating it into whole body movements and daily activities. (4) Retests assess changes in muscle activation, endurance, and coordination from the training.
This document provides an introduction to kinesiological electromyography (EMG). It discusses the basics of EMG including:
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- Key concepts for interpreting the EMG signal including recruitment, firing frequency, and the interference pattern resulting from the superposition of multiple motor unit action potentials.
- Guidelines for proper EMG signal acquisition and processing to obtain meaningful data on muscle function.
This document discusses surface electromyography (sEMG) scans, which allow chiropractors to detect elevated or imbalanced muscle activity that may be associated with spinal subluxations. The sEMG scan technology uses normative databases and statistical analysis of minute muscle measurements to provide an image of back muscle activity. Chiropractors can identify areas of elevated muscle activity along the spine and imbalances across the spine. Repeated sEMG scans during treatment allow monitoring of patient progress by comparing readings over time. The results help chiropractors provide more effective treatment and documentation.
This pilot study assessed the efficacy of electromyogram (EMG)-triggered neuromuscular stimulation (EMG-stim) for improving arm function in acute stroke survivors. Nine subjects within 6 weeks of their first stroke were randomly assigned to an EMG-stim group or control group. The EMG-stim group received two 30-minute EMG-stim sessions per day during rehabilitation, while the control group received wrist strengthening exercises without EMG-stim. Subjects treated with EMG-stim showed significantly greater gains in Fugl-Meyer motor assessment scores and Functional Independence Measure scores compared to the control group, suggesting that EMG-stim enhances arm function in acute stroke survivors.
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Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
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ZMPCZM016000.11.07 Analgesic effects of TENS & IFC on heat pain in healthy subjects
1. J Rehabil Med 2003; 35: 15–19
ANALGESIC EFFECTS OF TRANSCUTANEOUS ELECTRICAL NERVE
STIMULATION AND INTERFERENTIAL CURRENTS ON HEAT PAIN IN
HEALTHY SUBJECTS
Gladys L. Y. Cheing and Christina W. Y. Hui-Chan
From the Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
This study examined whether transcutaneous electrical
nerve stimulation or interferential current was more
effective in reducing experimentally induced heat pain.
Forty-eight young healthy subjects were randomly divided
into the following groups: (i) transcutaneous electrical nerve
stimulation; (ii) interferential current; and (iii) no stimulation. A multi-function electrical stimulator was used to
generate the transcutaneous electrical nerve stimulation or
interferential current. A thermal sensory analyser was used
to record the heat pain threshold. The stimulation lasted for
30 minutes and the heat pain thresholds were measured
before, during and after the stimulation. Transcutaneous
electrical nerve stimulation (p = 0.003) and interferential
current (p = 0.004) significantly elevated the heat pain
threshold, but ‘‘no stimulation’’ did not. The thresholds of
the transcutaneous electrical nerve stimulation and interferential current groups were significantly higher than that
of the control group 30 minutes into the stimulation
(p = 0.017). Both transcutaneous electrical nerve stimulation
and interferential current increased the heat pain threshold
to a similar extent during stimulation. However, the poststimulation effect of interferential current lasted longer than
that of transcutaneous electrical nerve stimulation.
Key words: TENS, IFC, heat pain threshold, pain.
J Rehabil Med 2003; 35: 15–19
Correspondence address: Gladys Cheing, Department of
Rehabilitation Sciences, The Hong Kong Polytechnic
University, Hung Hom, Kowloon, Hong Kong. E-mail:
rsgladys@polyu.edu.hk
Submitted December 14, 2001; accepted June 6, 2002
INTRODUCTION
Various therapeutic currents have been used for modulating
clinical pain. Transcutaneous electrical nerve stimulation
(TENS) is a low-frequency stimulator that delivers electrical
impulses at a frequency of 0–200 Hz. It has been shown to be an
effective treatment modality for various types of musculoskeletal pain (1) such as osteoarthritic knee (2, 3) and chronic
low back pain (4). Interferential current (IFC) is a mediumfrequency (3000–5100 Hz) alternating current with a beat
frequency ranging from 0 to 250 Hz (5). Compared with a low
2003 Taylor & Francis. ISSN 1650–1977
frequency current (about 100 Hz for TENS), IFC produces lower
impedance on skin and subcutaneous tissue, therefore the
theoretical penetration power should be deeper than that of
TENS (5). Studies have demonstrated that IFC is effective in
managing pain conditions such as migraine (6) and muscle
soreness (7). However, due to the large variability of clinical
pain, Taylor et al. (8) did not find any significant difference
between the IFC group and the placebo group in managing
recurrent jaw pain.
Some research has been carried out into the effect of electrical
stimulation on experimental cold-induced pain. Asthon et al. (9)
initially did not find that 100 Hz TENS elevated experimentally
induced cold pain threshold. However, the same group of
researchers (10, 11) confirmed that TENS did elevate cold pain
thresholds significantly. Similarly, studies have also shown that
IFC delivered at 100 Hz significantly increases ice pain thresholds in healthy subjects, in contrast to no change in the control
group (12, 13). Although Stephenson & Johnson (12) postulated
that IFC might produce greater antinociceptive effects than
TENS when comparing their results with those of previous
studies (10, 11, 14), their postulation was disproved by their
later research findings (15). Johnson & Tabasam (15) compared
the analgesic effects of IFC, TENS and placebo stimulation on
cold-induced pain. No significant differences in the pain
intensity or unpleasantness ratings were found among the 3
treatment groups. Their findings suggested no differences in the
analgesic effects of inferential currents and TENS on coldinduced pain.
Despite the couple of studies done on cold-induced pain, very
few studies have been carried out to investigate the influence of
electrical stimulation on heat pain. It has been reported that
TENS significantly increased experimentally induced heat pain
on the cheek in healthy subjects (16). No study has compared the
influence of TENS and IFC on heat pain thresholds. TENS and
IFC are likely to stimulate similar afferent fibres (i.e. the Aa and
Ab fibres). Since the measurement of heat pain threshold in the
present study was completed within only a few seconds, it is
likely that the measurement mainly involves the fast pain
transmission by the A fibres. This study examined whether 30
minutes of TENS or IFC would alter the heat pain threshold in
normal healthy subjects. We compared the changes of heat pain
threshold before, during and after TENS or IFC; and examined
whether or not the heat pain thresholds of these 2 groups would
J Rehabil Med 35
2. 16
G. L. Y. Cheing and C. W. Y. Hui-Chan
Table I. Demographic characteristics of the subjects (n = 48)
TENS
Age (years; mean Æ SD)
Gender (% of female)
Body mass index (mean Æ SD)
Skin fold of forearm (mm; mean Æ SD)
IFC
Control
p
21.4 Æ 1.9
50
20.5 Æ 1.9
5.0 Æ 2.5
20.8 Æ 1.3
50
20.8 Æ 3.2
6.4 Æ 3.0
21.6 Æ 1.1
50
20.4 Æ 1.6
4.3 Æ 1.7
0.289
1
0.881
0.059
TENS = transcutaneous electrical nerve stimulation; IFC = interferential current.
Fig. 2. The recordings of heat pain threshold at various time intervals during the study. T1,and T2 were the baseline measurements of heat
pain threshold. T3 and T4 were the measurements of heat pain threshold during the intervention; whereas T5 and T6 were the measurements
after the stimulation.
be different from that of the control group, which received no
stimulation.
MATERIALS AND METHODS
Subjects
Forty-eight volunteer healthy university students (24 males, 24 females),
aged 18–27 years, were recruited from the university. The baseline
demographic data of the TENS, IFC and control groups were compared
(Table I). Healthy subjects were recruited because pathological problems
may influence the pain perception of experimental pain. The exclusion
criteria were peripheral vascular disease, diabetes mellitus, tumour, skin
infection, neurological signs, cardiac pacemaker, arrhythmia and
abnormal skin sensation. The subjects were stratified by gender, then
randomly divided into 3 groups: the TENS group, the IFC group and the
control group. There were 16 subjects in each group, with males and
females split evenly. The aims and procedures of the experiment were
explained to the subjects and their consent was obtained.
reduce their resistance to the electrical current, the skin of the dominant
anterior forearm was cleaned thoroughly before the electrodes were
placed on it. All electrodes were fixed in position by Velcro straps
throughout the experiment (Fig. 1).
Two baseline measurements were obtained before the intervention,
which lasted for 30 minutes. Heat pain threshold (° C) was recorded at a
15-minute interval before, during and after the intervention, respectively
(Fig. 2). There were a total of 6 recording periods, with 4 trials of heat
pain threshold taken in each recording period. The total duration of the
Procedures
A multi-function electrical stimulator was used. Four flexible rubber
plate 3 cm  4 cm electrodes were placed in damp sponge covers for
delivering the IFC and TENS currents. The parameters of the IFC
stimulation were amplitude modulated at the frequency of 100 Hz. The
stimulation intensity was 3 times that of the sensory threshold. For the
TENS group, a continuous mode of stimulation was used, with a pulse
width of 120 ms and the frequency at 100 Hz. The stimulation intensity
used in the 2 groups was the same.
Prior to the actual recording, a sharp and blunt sensation test was
carried out to ensure normal skin sensation. Subjects practised the
experimental procedures for 30 seconds, receiving stimulation on their
non-experimental forearms. Therefore, each subject had experienced the
electrical stimulation before the experiment took place. In order to
J Rehabil Med 35
Fig. 1. The testing position for the heat pain threshold by the
Thermal Sensory Medoc Analyzer TSA-2001. The 4 flexible rubber
plate electrodes were placed in damp sponge covers and were fixed
with Velcro straps. The thermode of the analyser was placed in the
middle of the 4 electrodes.
3. Analgesic effects of TENS and IFC
17
Table II. Recorded heat pain threshold for the transcutaneous electrical nerve stimulation (TENS); interferential current (IFC) and control
groups during the study (mean Æ SD)
Time
T1
Pre-treatment
(À15 min)
T2
Pre-treatment
(0 min)
T3
During treatment
(15 min)
T4
During treatment
(30 min)
T5
T6
Post-treatment Post-treatment
(45 min)
(60 min)
TENS
IFT
Control
p-valuesb
41.6 Æ 3.8
41.2 Æ 4.2
40.6 Æ 4.0
0.412
42.0 Æ 3.6
41.6 Æ 4.5
40.4 Æ 3.9
0.412
43.6 Æ 4.5
43.1 Æ 4.1
40.6 Æ 3.8
0.079
43.9 Æ 3.6
43.4 Æ 4.3
40.3 Æ 3.6
0.017
42.4 Æ 3.7
42.9 Æ 4.2
40.5 Æ 3.6
0.067
a
b
42.0 Æ 3.3
42.3 Æ 3.9
40.6 Æ 3.7
0.253
pa
0.003
0.004
0.994
p values comparing results at different time within each group.
p values comparing different groups at each time.
experiment lasted for 75 minutes. To reduce the accommodation effect,
the intensity of the current in both TENS and IFC groups was increased
by 10% at 15 minutes into the stimulation. The control group did not
receive any electrical stimulation and no electrodes were placed on their
forearms.
Testing was done in a quiet, isolated room. The room temperature was
maintained at 21° C. A thermal sensory analyser consisting of a
30 mm  30 mm thermode was placed distally to the proximal one-third
of the anterior forearm of the dominant hand, which was between the
elbow crease and distal crease of the wrist. The location of the thermode
on the forearm was marked on the skin. The thermode was attached to
the subject’s forearm by tightening the Velcro strap by 2 cm, and a mark
was made on the strap. A build-in computer program in the thermal
analyser controlled the heating process of the thermode. The baseline
measurement of the pain threshold was taken at the beginning of the
experiment (À15 min). The temperature of the thermode was increased
from 32° C at a rate of 1.5° C per second to avoid accommodation of the
temperature rise. The highest temperature induced in the thermode was
50° C, to avoid the risk of burning the patient. When the subjects started
to feel the heat pain, they were requested to press the mouse immediately
with the non-dominant hand. The thermode was removed at the end of
each recording period for better heat dissipation.
Data analysis
Repeated measures ANOVA followed by contrast were used to analyse
the absolute data. The within-subject factor was “time” and the betweensubject factor was “group”. Normalized heat pain thresholds with respect
to the pre-stimulation baseline observation using the formula were also
calculated:
Tn
 100%
…T1 ‡ T2 † Ä 2
where n = 1, 2, 3, … 6, as shown in Figure 2.
T1, T2 are the baseline measurements of heat pain threshold.
RESULTS
No significant group difference was found in heat pain threshold
at the baseline, as shown in Table II. The 2 pre-treatment values
indicate that the baselines were very stable in all 3 groups. As
significant interaction was found between “time” and “group”
(p = 0.008), the analyses were performed separately.
Table III showed the heat pain thresholds that were normalized with the baseline measurement recorded at T1 and T2. For
the TENS group, the heat pain threshold showed significant
changes over time (p = 0.003). It increased to 104.3 Æ 6.7% of
the normalized value at T3 (p = 0.013) and 105.2 Æ 6.6% at T4
(p = 0.004), both significantly different from the baseline, i.e.
(T1 ‡ T2)/2 (Fig. 3). It then decreased to 100.6 Æ 3.7% at T6, i.e.
almost back to the baseline level. Similarly, for the IFC group,
the heat pain threshold increased significantly over time
(p = 0.004). The normalized heat pain threshold rose to
104.4 Æ 6.9 % of the control value at T3 (p = 0.026) and further
increased to 105.0 Æ 7.2% at T4 (p = 0.020). It then gradually
decreased to 102.5 Æ 2.9 % at T6. However, contrast comparisons showed that the heat pain thresholds of the IFC group at T5
(103.9 Æ 3.5%; p = 0.001) and T6 (102.5 Æ 2.9%, p = 0.004)
were still significantly higher than the baseline. In other words,
30 minutes of IFC significantly elevated the heat pain threshold
during the stimulation, and the effect lasted for at least 30
minutes after the stimulation. On the other hand, no significant
change in the heat pain threshold was found in the control group
throughout the study period (p = 0.994). The threshold of the
control group remained roughly unchanged from T1 to T6.
However, there was no significant between-group difference
after the intervention, i.e. T5 and T6 (all p 0.05).
For between-group comparisons, significant differences
among 3 groups were found at T4 (p = 0.017), i.e. 30 minutes
into the stimulation. Contrast comparisons indicated that the
Table III. Normalized heat pain threshold in the transcutaneous electrical nerve stimulation (TENS); interferential current (IFC) and control
groups over time (mean Æ SD)
Time
T1
Pre-treatment
(À15 min)
T2
Pre-treatment
(0 min)
T3
During treatment
(15 min)
T4
During treatment
(30 min)
T5
Post-treatment
(45 min)
T6
Post-treatment
(60 min)
p
TENS
IFT
Control
99.4 Æ 1.6
99.5 Æ 2.0
100.2 Æ 2.0
100.6 Æ 1.6
100.5 Æ 2.0
99.8 Æ 2.0
104.3 Æ 6.7
104.4 Æ 6.9
100.1 Æ 3.8
105.2 Æ 6.6
105.0 Æ 7.1
99.6 Æ 3.8
101.5 Æ 5.1
103.9 Æ 3.5
100.2 Æ 4.8
100.6 Æ 3.7
102.5 Æ 2.9
100.3 Æ 5.2
0.001
0.006
0.851
J Rehabil Med 35
4. 18
G. L. Y. Cheing and C. W. Y. Hui-Chan
Fig. 3. The thermal pain threshold increased gradually from the
baseline value to 105.2% in the transcutaneous electrical nerve
stimulation (TENS r) group (p = 0.004) and 105.0% in the
interferential current (IFC j) group (p = 0.020) at T4 i.e. 30
minutes into the stimulation. In contrast, there was no significant
change in the heat pain threshold for the control group (m). The
between-group difference reached significance at T4 (p = 0.017).
heat pain thresholds of the TENS and IFC groups were
significantly higher than the control group at T4, but that there
was no significant difference between the TENS and IFC groups.
DISCUSSION
To the best of our knowledge, this experiment is the first study
comparing the influence of IFC and TENS on heat-induced pain
threshold. We demonstrated that 30 minutes of TENS or IFC,
but not the control group, significantly elevated heat pain
threshold during stimulation in young healthy people. The
influence of TENS and IFC on heat pain threshold peaked at 30
minutes into the stimulation (i.e. T4). After the stimulation (from
T5 to T6), the heat pain threshold in both groups tended to drop.
However, this drop was slower in the IFC group than in the
TENS group. In other words, the antinociceptive effects of
TENS occurred mainly during stimulation, but the effect of IFC
lasted at least up to 30 minutes after stimulation. This could be
due to the stronger penetration power of IFC.
Our results are consistent with those reported by Marchand et
al. (16). They investigated the heat pain threshold on the cheek
before, during and after 15 minutes of TENS treatment in
healthy subjects. They demonstrated that TENS significantly
increased the heat pain threshold during stimulation, compared
with the baseline value. However, the threshold regressed back
to the baseline level after stimulation. In the present study, even
though we applied TENS for a longer duration (30 minutes), the
post-stimulation heat pain threshold was not significantly
different from the baseline value (p 0.05). In contrast, our
findings demonstrated that the antinociceptive effect of IFC
outlasted the stimulation, and thus was longer than that produced
J Rehabil Med 35
by TENS. The influence of IFC on heat pain threshold was
significantly higher than the baseline value even 30 minutes
after stimulation.
As both TENS and IFC are afferent stimulations that are
applied to the skin, it is likely that their analgesic mechanisms
are similar, probably involving the gate control theory, the
physiological block and the endogenous pain inhibitory system.
The gate control theory was proposed by Melzack Wall
(17) in 1965. They suggested that the substantia gelatinosa in the
dorsal horn of the spinal cord acts as a gate control system.
Activation of the large diameter myelinated fibers subserving
touch, pressure and vibration (i.e. the Aa and Ab fibres) is
thought to facilitate the pre-synaptic inhibition of substantia
gelatinosa cells on the transmission cells in the dorsal horn, thus
reducing pain transmission. TENS is supposed to excite
predominantly Aa or Ab fibres, which may reduce the output
of the transmission cells, thus reducing the perception of heat
pain. This could partly explain why subjects reported an increase
in their heat pain thresholds in this study.
The other antinociceptive mechanism is physiological block
(18). The C fibres are able to fire when the frequency of an
electrical stimulus is below 15 Hz. When the frequency of
stimulation increases, the conduction in the C fibres decreases.
The application of an electrical stimulus above 50 Hz may result
in a physiological block. For A fibres, the physiological block
occurs at a higher frequency of 40 Hz. Since both TENS and IFC
were applied at 100 Hz in this experiment, a physiological block
may have occurred, thus increasing the heat pain threshold.
The endogenous pain inhibitory system is also a wellaccepted antinociceptive mechanism. Basbaum Field
(19, 20) proposed that there is a neural network including the
midbrain, medulla, and spinal cord levels that monitors and
modulates the activity of pain-transmitting neurons. Woolf et al.
(21) demonstrated that peripheral electrical stimulation could
also excite naloxone-dependent antinociceptive mechanisms,
i.e. the endogenous opioid system operating at both spinal and
supraspinal levels. If this is the case, it may have led to a
reduction in pain perception and an increase in heat pain
threshold in the present study.
Our results suggest that the antinociceptive effect produced by
IFC is more prolonged than that of TENS. This may be due to the
fact that IFC is a medium frequency current that exerts lower
resistance to skin than TENS (a low frequency stimulation).
Therefore, IFC is likely to be more effective in penetrating
through the skin and stimulating the deep nerve tissues underneath. Palmer et al. (22) examined the effects of different IFC and
TENS frequencies on sensory, motor and pain thresholds. They
found that both IFC and TENS displayed a significant frequencydependent effect for each threshold. However, IFC was not any
better than TENS at increasing the sensory, motor or pain
thresholds at different stimulation frequencies. Future studies are
needed to examine how the penetrating power of therapeutic
currents could affect the antinociceptive effects in humans.
The present study was done on experimental pain because it is
a simpler model to test for the effectiveness of pain treatment.
5. Analgesic effects of TENS and IFC
Experimental pain is usually induced in a standardized way in
healthy subjects. As they are relatively homogeneous within a
group, the different responses of different groups could be
explained by group allocation, rather than individual variations.
In contrast, patients suffering from clinical pain tend to have
variations in terms of the history, severity or cause of pain. It is
difficult to form a homogeneous group at the baseline. As a
result, patients within a group may respond differently to the
same intervention. However, further studies need to be
conducted to compare the relative effectiveness of TENS and
IFC on clinical pain, because experimental pain may differ from
clinical pain in some aspects. The heat-induced pain applied in
our study is a localized, well-defined and sharp sensation, which
is similar in nature to acute pain. However, clinical pain could
involve chronic pain, which often involves a diffuse and dull
sensation (23). These 2 types of pain are also different in the
affective aspect; one may be more anxious about experimental
pain but more depressed about clinical pain. Therefore, the
relative effectiveness of the therapeutic currents may vary with
these 2 types of pain. Further studies are needed to compare the
effectiveness of IFC and TENS in managing clinical pain.
8.
9.
10.
11.
12.
13.
14.
15.
ACKNOWLEDGEMENT
The authors thank The Hong Kong Polytechnic University for
financial support of the project.
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