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).

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.

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.

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.

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.

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.

Tumor-Treating Fields: Nursing Implications for an Emerging Technology
.

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.
.

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.

[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.

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.

Spinal cord stimulation for chronic intractable pain: nursing implications.

Spinal cord stimulation (SCS) became available in the 1970s as a treatment option for patients with constant or recurring pain. This invasive procedure is performed after all other efforts have failed to prove effective in controlling pain. Advanced technology enables the patient to perform adjustments to maximize comfort with the use of a magnet or portable programmer. Nursing care is guided by a specific plan of care for the SCS patient population. A patient population-specific standard may be useful.

Vagus nerve stimulator as a treatment for intractable epilepsy.

Vagus nerve stimulation was recently approved for control of medically intractable seizures. This therapy provides some relief of seizures for selective patients, however seizure freedom using this device is uncommon. Vagus nerve stimulation appears to work by calming "hyperexcited" nerve cells and reverting brain activity to its normal patterns. Many people do have significant relief in the intensity and duration of their seizures and report improved quality of life using this device.

Vagus nerve stimulation for intractable seizures: one year follow-up.

Even with the best health care available, many patients with epilepsy still suffer from poorly controlled seizures. Patients with intractable partial seizures are often inhibited from realizing their full potential and may experience a less than optimal quality of life. Vagus nerve stimulation (VNS) is being studied in a double-blind, controlled, randomized trial at 17 epilepsy centers throughout the U.S. and Europe as a potential therapy for patients with refractory seizures. During a 14-week controlled phase in three of the centers, the therapeutic group (N = 10) experienced a mean seizure frequency percent reduction (SFPR) of 33.1% as compared to baseline (p = 0.0084) while the subtherapeutic group (N = 12) experienced an SFPR of 0.6% as compared to baseline (p = 0.9183). After the controlled phase, all patients were switched into the therapeutic group in an open extension phase. Results after one year of therapeutic stimulation (N = 15) reveal a mean SFPR of 35.6% (p = 0.0088) with 6 of the 15 patients (40%) achieving at least a 50% seizure reduction. Adverse effects included hoarseness, coughing and nausea. There were no deaths or serious injuries related to the device. Based on these limited data, VNS appears to be a safe and efficacious new therapy for refractory partial seizures.

Practical issues and concepts in vagus nerve stimulation: a nursing review.

Estimates of epilepsy incidence among the U.S. population range between 0.5% and 1%. The most common type of seizure in adult patients is partial onset. Approximately 20% of these patients are refractory to antiepileptic drug therapy and experience intolerable side effects such as confusion, dizziness, weight gain, lethargy, and ataxia. The ketogenic diet appears to be beneficial for children but is not considered a standard option for adults. Epilepsy surgery can be an option for many and may offer control or a reduction in seizures. However, many patients are opposed to cranial surgery or may not tolerate the ketogenic diet. Recent advances in biomedical technology and perfection in surgical techniques have shown vagus nerve stimulation (VNS) using the Neuro Cybernetic Prosthesis (NCP) system is an effective new treatment option in reducing seizure frequency. On July 16, 1997, the U.S. Food and Drug Administration (FDA) approved the use of the NCP for vagus nerve stimulation, as an adjunctive treatment for refractory partial onset seizures in adults and adolescents over 12 years of age. Murphy et al. and Wheless have reported similar results in children younger than 12 years. VNS represents the first therapy using a medical device approved by the FDA for the treatment of refractory seizures. An estimated 10,000 patients have been implanted with the device.

Treating ununited fractures with electricity: nursing implications.

Not only are the elderly more susceptible to fractures because of a decrease in total bone content from osteoporosis, but the regeneration of injured bone may be prolonged as well. When a long bone fracture occurs in the elderly person, weightlessness and immobility result in further acceleration of bone loss. Because the success of pulsing electromagnetic field treatments depends on adherence to the treatment protocol, patient education is a key in nursing care. Although all fractures are a serious setback for the elderly person, those that do not heal properly require special considerations and the mobilization of many resources if the patient is to remain out of an institution.

Spinal cord stimulation for chronic, nonmalignant pain.

Chronic, nonmalignant pain differs from acute pain and cancer pain and can have a significant impact on people's lives. Many therapeutic modalities have been attempted for relief of this pain with varying degrees of success. These include opioid analgesics, relaxation methods, nerve blocks, transcutaneous electrical nerve stimulation (TENS), and spinal cord stimulation (SCS). SCS has been successful in decreasing nonmalignant pain when other methods have failed. Nurses play an active role in caring for patients receiving SCS through patient education, psychologic support, and programming the spinal cord stimulator. Because of the active role nurses take in pain management, a knowledge of pain transmission and the techniques and efficacy of spinal cord stimulation is important.