Tumor-Treating Fields: Nursing Implications for an Emerging Technology
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Tumor-treating fields (TTFields) are a new technology used for cancer treatment consisting of battery-powered, insulated electromagnetic transducers that are placed on the scalp. This wearable, adhesive device is a certified physician-prescribed therapy for patients with glioblastoma multiforme, a type of primary brain cancer. TTFields are being used concomitantly with temozolomide (Temodar®) in patients with newly diagnosed glioblastoma and as a monotherapy in patients with recurrent glioblastoma after radiation therapy and chemotherapy. Nursing professionals caring for patients using this emerging technology should be able to educate patients regarding proper use of TTFields and monitor for side effects.
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Cranial electrical stimulation improves symptoms and functional status in individuals with fibromyalgia.

To investigate the effects of microcurrent cranial electrical stimulation (CES) therapy on reducing pain and its associated symptoms in fibromyalgia (FM), we conducted a randomized, controlled, three-group (active CES device, sham device, and usual care alone [UC]), double-blind study to determine the potential benefit of CES therapy for symptom management in FM. Those individuals using the active CES device had a greater decrease in average pain (p = .023), fatigue (p = .071), and sleep disturbance (p = .001) than individuals using the sham device or those receiving usual care alone over time. Additionally, individuals using the active CES device had improved functional status versus the sham device and UC groups over time (p = .028).

Posterior tibial nerve stimulation for faecal incontinence.

Faecal incontinence is a common multifactorial condition with a range of invasive treatment options, all of which may be associated with significant complications. Posterior tibial stimulation by continence nurses is an established treatment for urinary incontinence; however, its use in faecal incontinence, while rapidly evolving, is limited to eight small and differing studies. In this article, the background of current management options for faecal incontinence is discussed, as are the physiology and evidence underlying neuromodulation. The evidence base for posterior tibial nerve stimulation in faecal incontinence is reviewed, as well as the implications for practice and further research. While this early evidence base is encouraging, it has yet to be established whether this novel approach may be the minimally invasive, effective and cheap treatment hoped for, for this common and debilitating condition.

Overview of complex regional pain syndrome and recent management using spinal cord stimulation.

Complex regional pain syndrome (CRPS) is an enigmatic disease process affecting the upper and lower extremities. It consists of various combinations of sensory, autonomic, and motor abnormalities, the pathogenesis of which is unclear. Formally known as reflex sympathetic dystrophy or causalgia, CRPS has a revised taxonomy since 1994. The International Association for the Study of Pain established 2 categories, type I and type II, based on precipitating events. This syndrome manifests in 3 progressive stages, displaying peripheral and central neurologic aberrancies. The exact triggering mechanism is unclear but appears to involve neurogenic inflammation from axonal damage to small-fiber distal nerves. Central sensitization independent of afferent input and central somatotopic reorganization may be contributory in successive stages. Treatment goals are twofold: management of pain and restoration of function. Time is critical, as therapeutic effectiveness is limited in the latter stage. Various treatment modalities, including medication regimens, sympathetic nerve blocks, and physical therapy have met with differing degrees of success. Recent advances in spinal cord stimulation are promising. Although initially costly, this may prove to be the least expensive and most effective treatment in the long-term.

Sacral nerve stimulation for the management of faecal incontinence.

Faecal incontinence is a distressing and embarrassing problem that can have a profound affect upon quality of life. The true incidence is unclear, as figures from studies vary depending on the definition used and the population studied. Data from a comprehensive study by Nelson et al (1995) found that 2.2% of the population has faecal incontinence and 10% of those have severe symptoms. The incidence increases with age (Perry, 2002) This article sets out to highlight the importance of assessment along with exploring appropriate conservative and surgical management options for faecal incontinence. If conservative management fails, sacral nerve stimulation (SNS) is one treatment option which is a minimally invasive technique allowing modulation of nerves and muscles in the pelvic floor. The procedure is carried out in two stages: the diagnostic stage involves a peripheral nerve evaluation (test) and a therapeutic stage involves permanent implantation of the stimulating device. Results from a recent study focusing on the medium term follow up for SNS will be presented.

Percutaneous tibial nerve stimulation for the treatment of urinary frequency, urinary urgency, and urge incontinence: results from a community-based clinic.

Overactive bladder affects 16% of the adult population. This retrospective analysis evaluated the application of percutaneous tibial nerve stimulation (PTNS), a minimally invasive neuromodulation therapy, in a population of patients who failed to achieve adequate control of symptoms of urinary urgency, urinary frequency, and urinary incontinence with conservative treatments. A course of 12 PTNS sessions was prescribed and administered in the context of an independent community-based, nurse practitioner-led continence practice. The results of this analysis indicated that patients treated with PTNS therapy experienced statistically significant decreases in both day and night voids, and in episodes of urge incontinence. This study confirmed the results of previous studies indicating that PTNS therapy is a safe and effective treatment that can be successfully incorporated in a community-based setting.

Effect of low-intensity direct current on the healing of chronic wounds: a literature review.

Few studies have assessed the effectiveness of electrical stimulation on chronic wounds. Nevertheless, the evidence suggests it is a potentially useful, accessible and cheap therapy, which might play a valuable role in everyday practice.

Controlling chronic pain in the workplace: nerve stimulation and intrathecal drug delivery systems.

Chronic pain can have a major effect on both workers and the workplace. Collaboration among workers, occupational health nurses, and specialist providers is important for ongoing management of mechanism-based therapies for chronic pain. This article examines collaborative care issues relative to nerve stimulation and intrathecal drug delivery systems.

Vagus nerve stimulation for severe depression.

Treatment-resistant depression is a serious problem with significant costs in terms of health care dollars and patients' well-being. Vagus nerve stimulation (VNS) is one novel, device-based therapy that may be effective in this population. In this article, we review the evidence to date on the use of VNS in major depression and describe the process of VNS treatment initiation, device implantation, and dosage adjustment and monitoring. It is important for psychiatric nurses to understand the evidence base for and how VNS is used in treatment so they may enhance care of patients with treatment-resistant depression.

Vagus nerve stimulation: treatment modality for epilepsy.

Anticonvulsant medication is the golden standard for treatment of epilepsy. For patients who do not benefit sufficiently from anticonvulsants, vagal nerve stimulation using an implantable electrical nerve stimulator may be an option to reduce seizure frequency and intensity, thus improving patients' quality of life. The results of a series of vagus nerve stimulator implantations are described.

[The effects of an electrical muscle stimulation program on chronic knee pain in the elderly: based on TE, SE, and SY].

PURPOSE: This study was to examine the effects of electrical muscle stimulation therapy on chronic knee pain in the elderly. METHOD: The research design was a one-group pretest-posttest design. The subjects were 45 (TE: 17, SE: 15, SY: 13) elderly,65 years old and above with chronic knee pain. Pain was measured by the S-F McGill Pain Questionnaire (S-F MPQ) and Arthritis Impact Measurement Scale (AIMS). Electrical muscle stimulation therapy experimental treatment was applied for 12 weeks, 3 times/week, 15 min/time. Data was collected from March 2005 to February 2006. Data was analyzed using the SPSS PC+ 12 version. RESULTS: After receiving electrical muscle stimulation therapy, chronic knee pain in TE (S-F MPQ: t=-62.143, p=.000, AIMS: t=-29.155, p=.000), SE (S-F MPQ: t=-76.345, p=.000, AIMS: t=-39.323, p=.000), and SY (S-F MPQ: t=-43.691, p=.000, AIMS: t=-30.306, p=.000) groups were significantly decreased. CONCLUSION: Electrical muscle stimulation therapy can be a better effective primary nursing intervention for chronic knee pain for community dwelling elderly people with TE, SE, and SY.

Treating a pressure ulcer with bio-electric stimulation therapy.

Mr Jones lived independently until he developed necrotic pressure ulcers over his heels and could no longer mobilize to care for himself. He was transferred to a nursing home where he lived for 18 months and where the nurses could care for his wounds. The wound had been on his right heel without changing over the 18 months and, although attempts to hydrate the eschar had been somewhat successful, the necrotic tissue proved stubborn creating large quantity of fibrous slough. Mr Jones was initially assessed by the tissue viability consultant on 14 March 2005 and agreed to the application of bio-electric stimulation therapy (POSiFEC). The wound change was immediate and was fully healed by 16 June 2005, 12 weeks after his initial assessment. This article outlines his care and the background to bio-electrical stimulation in wounds.

Healing an intractable wound using bio-electrical stimulation therapy.

Clinicians involved in the conservative care of chronic wounds have many treatment interventions from which to choose, including debridement/irrigation, dressings, and pressure-relieving devices, to name a few. All are physical treatments that create an ideal wound healing environment. Unfortunately, many wounds heal very slowly, do not heal, or worsen. This situation relates to the woman in this case study who had a non-healing leg ulcer for 12 months. One of the interventions commonly used to treat chronic wounds is bio-electrical stimulation therapy (BEST) and the rationale for use of this method is based on the fact that the human body has an endogenous bioelectric system that enhances healing of bone fractures and soft-tissue wounds. When the body's endogenous bioelectric system fails and cannot contribute to wound repair processes, therapeutic levels of electrical current may be delivered into the wound tissue from an external source.

Using technology to help alleviate pain.

Learn the latest pain management techniques of PCA pumps and implanted systems.