Update on sacral neuromodulation and overactive bladder in pediatrics: A systematic review. / Puesta al día en neuromodulación y vejiga hiperactiva en pediatría: una revisión sistemática.

OBJECTIVES: Sacral electrical stimulation has been used for more than a century as an alternative therapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this technique based on clinical and urodynamic criteria. Nevertheless, few studies have shown beneficial results in children with overactive bladder. MATERIAL AND METHODS: We performed a systematic review of studies assessing the impact of sacral electroestimulation treatment on overactive bladder in children. The search identified 389 potentially eligible items. Of them, 14 studies published between 2001and 2019 met the study criteria and were selected for systematic review. RESULTS: All of papers included in this review individually demonstrated a high efficiency rate with good shortterm results, as well as safety in its use due to its minimalrate of adverse effects. However, the comparison of the results obtained in all of them was not possible because the high variety and heterogeneity in the different studies. The main limitation is that there is still no standard protocol for the application of this therapy in the pediatric population. CONCLUSION: This review revealed the promising benefits of sacral electroneuromodulation in pediatric patients with overactive bladder. However, more studies with strictly meet pediatric overactive bladder diagnosis and management criteria should be done to protocolize and clarify the effectiveness of this therapeutic approach.

OBJETIVO: La estimulación eléctrica a nivel sacro ha sido usada durante más de un siglo como una alternativa terapéutica más en el manejo de los síndromes urinarios entre la población adulta. A lo largo de la literatura múltiples estudios han corroborado la eficacia de esta técnica, basándose en resultados clínicos y criterios urodinámicos. Sin embargo, son escasos los estudios que analizan los potenciales beneficios de esta modalidad terapéutica en niños con vejiga hiperactiva.MATERIAL Y MÉTODOS: Realizamos una revisión sistemática de los estudios que analizan el impacto de la electroestimulación nerviosa sacra en el tratamiento de la vejiga hiperactiva en pediatría. La búsqueda identificó 389 trabajos potencialmente elegibles. De entre todos ellos, 14 estudios publicados entre 2001 y 2019 reunieron los criterios adecuados para ser seleccionados y formaron parte de la presente revisión sistemática. RESULTADOS: Todos los estudios incluidos en esta revisión demostraron de forma individual la alta eficacia y unos buenos resultados a corto plazo con esta terapia, así como su seguridad, dada la baja tasa de efectos adversos de la misma. Sin embargo, la comparación de estos resultados en todos estos estudios no fue posible, debido a la gran variedad y heterogeneidad en la metodología y la forma de expresión de los resultados entre todos ellos. El motivo que genera esta gran diversidad de resultados entre los diferentes trabajos incluidos en esta revisión es la falta de un protocolo estándar para la aplicación de esta terapia en la población pediátrica.CONCLUSIÓN: En conclusión, esta revisión revela los prometedores beneficios de la electroterapia nerviosaa nivel sacro en los pacientes pediátricos con vejiga hiperactiva. Sin embargo, es necesario realizar más estudios que analicen los efectos de este tratamiento. La metodología de los mismos deberá ser estricta, con unos criterios estandarizados sobre la inclusión de los pacientes, el diagnóstico de vejiga hiperactiva, y la medición de la eficacia obtenida. Así, será posible realizar protocolos de aplicación de esta modalidad terapéutica, y sus efectos podrán ser esclarecidos.

Update on sacral neuromodulation and overactive bladder in pediatrics: a systematic review / Actualización en neuromodulación sacra y vejiga hiperactiva en pediatría: una revisión sistemática

Objetives: Sacral electrical stimulationhas been used for more than a century as an alternativetherapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this techniquebased on clinical and urodynamic criteria. Nevertheless,few studies have shown beneficial results in children withoveractive bladder.Material and methods: We performed a systematic review of studies assessing the impact of sacralelectroestimulation treatment on overactive bladder inchildren. The search identified 389 potentially eligibleitems. Of them, 14 studies published between 2001and 2019 met the study criteria and were selected forsystematic review. Results: All of papers included in this review individually demonstrated a high efficiency rate with good shortterm results, as well as safety in its use due to its minimalrate of adverse effects. However, the comparison of theresults obtained in all of them was not possible becausethe high variety and heterogeneity in the different studies. The main limitation is that there is still no standardprotocol for the application of this therapy in the pediatric population.Conclusions: This review revealed the promisingbenefits of sacral electroneuromodulation in pediatricpatients with overactive bladder. However, more studieswith strictly meet pediatric overactive bladder diagnosisand management criteria should be done to protocolizeand clarify the effectiveness of this therapeutic approach.(AU)

Objetivos: La estimulación eléctrica a nivel sacro ha sido usada durante más de un siglo comouna alternativa terapéutica más en el manejo de los síndromes urinarios entre la población adulta. A lo largode la literatura múltiples estudios han corroborado la eficacia de esta técnica, basándose en resultados clínicosy criterios urodinámicos. Sin embargo, son escasos losestudios que analizan los potenciales beneficios de estamodalidad terapéutica en niños con vejiga hiperactiva.Material y métodos: Realizamos una revisión sistemática de los estudios que analizan el impacto de laelectroestimulación nerviosa sacra en el tratamiento de a vejiga hiperactiva en pediatría. La búsqueda identi-ficó 389 trabajos potencialmente elegibles. De entretodos ellos, 14 estudios publicados entre 2001 y 2019reunieron los criterios adecuados para ser seleccionados y formaron parte de la presente revisión sistemática.Resultados: Todos los estudios incluidos en esta revisión demostraron de forma individual la alta eficacia yunos buenos resultados a corto plazo con esta terapia,así como su seguridad, dada la baja tasa de efectosadversos de la misma. Sin embargo, la comparaciónde estos resultados en todos estos estudios no fue posible, debido a la gran variedad y heterogeneidad en lametodología y la forma de expresión de los resultadosentre todos ellos. El motivo que genera esta gran diversidad de resultados entre los diferentes trabajos incluidosen esta revisión es la falta de un protocolo estándarpara la aplicación de esta terapia en la población pediátrica.Conclusion: En conclusión, esta revisión revela losprometedores beneficios de la electroterapia nerviosaa nivel sacro en los pacientes pediátricos con vejigahiperactiva. Sin embargo, es necesario realizar másestudios que analicen los efectos de este tratamiento.La metodología de los mismos deberá ser estricta, conunos criterios estandarizados sobre la inclusión de los...(AU)

[Analgesic effects of transcutaneous electrical nerve stimulation (TENS) in patients with fibromyalgia: A systematic review]. / Efectos analgésicos de la estimulación eléctrica nerviosa transcutánea en pacientes con fibromialgia: una revisión sistemática.

OBJECTIVE: To determine whether transcutaneous electrical nerve stimulation (TENS) has an analgesic effect greater than placebo or other treatments in patients with fibromyalgia. Furthermore, it was intended to analyze the optimal application parameters to achieve a greater reduction of pain. DESIGN: A systematic review. DATA SOURCE: Randomized clinical trials on the effect of TENS on fibromyalgia in the databases Pubmed, Cochrane and PEDro until November 2016. SELECTION OF STUDIES: 8 studies out of a total of 62 were selected. Controlled clinical trials in which TENS was applied in patients with fibromyalgia were included. DATA EXTRACTION: Pain was analyzed as the main variable, although other variables such as fatigue, quality of life and impact, range of motion and depression were also included. RESULTS: 6 out of 8 studies obtained a significant decrease of pain. In 2 studies, TENS was applied as complementary treatment to therapeutic exercise with results evidencing a decrease in pain. The rest of the variables studied presented a great variability and conclusive results could not be established. CONCLUSIONS: Treatment with TENS is effective for reducing pain in people with fibromyalgia. In addition, the inclusion of TENS in therapeutic exercise programs seems to have a greater effect than practicing therapeutic exercise in isolation. However, no efficacy has been demonstrated in other variables different to pain. Further studies are needed to investigate the optimization of the parameters of the TENS and a greater consensus among the variables used.

Transcutaneous electrical nerve stimulation for spasticity: A systematic review. / Estimulación eléctrica nerviosa transcutánea como tratamiento de la espasticidad: una revisión sistemática.

INTRODUCTION: Although transcutaneous electrical nerve stimulation (TENS) has traditionally been used to treat pain, some studies have observed decreased spasticity after use of this technique. However, its use in clinical practice is still limited. Our purpose was twofold: to determine whether TENS is effective for treating spasticity or associated symptoms in patients with neurological involvement, and to determine which stimulation parameters exert the greatest effect on variables associated with spasticity. DEVELOPMENT: Two independent reviewers used PubMed, PEDro, and Cochrane databases to search for randomised clinical trials addressing TENS and spasticity published before 12 May 2015, and selected the articles that met the inclusion criteria. Of the initial 96 articles, 86 were excluded. The remaining 10 articles present results from 207 patients with a cerebrovascular accident, 84 with multiple sclerosis, and 39 with spinal cord lesions. CONCLUSIONS: In light of our results, we recommend TENS as a treatment for spasticity due to its low cost, ease of use, and absence of adverse reactions. However, the great variability in the types of stimulation used in the studies, and the differences in parameters and variables, make it difficult to assess and compare any results that might objectively determine the effectiveness of this technique and show how to optimise parameters.

Transcutaneous Electrical Nerve Stimulation Reduces Post-Thoractomy Ipsilateral Shoulder Pain. A Prospective Randomized Study.

OBJECTIVES: The patient's position during an axillary thoracotomy can cause postoperative pain and decrease mobility of the ipsilateral shoulder. In this study, we assessed whether the implementation of a standardized analgesia program using transcutaneous electrical nerve stimulation (TENS) decreases local pain and improves ipsilateral shoulder mobility. METHOD: Randomized, single-blind, single-center clinical trial of 50 patients who had undergone anatomical lung resection via axillary muscle-sparing thoracotomy. Patients were treated with TENS devices for 30 minutes every 8 hours, beginning on postoperative day 1. Pain and mobility of the affected limb were recorded at the same time on postoperative days 1 through 3. A visual analogue scale was used for pain assessment and shoulder mobility was assessed with a goniometer. Results were compared using a non-parametric test. RESULTS: Twenty-five patients were randomized to each group. Mean age of the control group was 62.7±9.3 years and 63.4±10.2 years in the experimental group. Shoulder mobility parameters were similar in both groups on all postoperative days. However, pain during flexion significantly decreased on day 2 (P=.03) and day 3 (P=.04) in the experimental group. CONCLUSION: The use of TENS decreases pain from shoulder flexion in patients undergoing axillary thoracotomy for pulmonary resection.

Evaluation of the noradrenergic pathway and alpha-2 and beta-receptors in the modulation of the analgesia induced by transcutaneous electric nerve stimulation of high and low frequencies / Evaluación de la vía noradrenérgica y de los receptores alfa-2 y beta en la modulación de analgesia inducida por la estimulación eléctrica nerviosa transcutánea con alta y baja frecuencia / Avaliação da via noradrenérgica e dos receptores alfa-2 e beta na modulação da analgesia induzida pela estimulação elétrica nervosa transcutânea de alta e de baixa frequência

Transcutaneous electric nerve stimulation is a noninvasive method used in clinical Physiotherapy to control acute or chronic pain. Different theories have been proposed to explain the mechanism of the analgesic action of transcutaneous electric nerve stimulation, as the participation of central and peripheral neurotransmitters. The aim of this study was to evaluate the involvement of noradrenergic pathway and of the receptors alfa-2 and beta in the modulation of analgesia produced by transcutaneous electric nerve stimulation of high and low frequency in Wistar rats after chronic treatment with propranolol or yohimbine intraperitoneally. Animals weighing 200 to 300 g were divided into 9 groups (n=8), which were obtained nociceptive thresholds through the Tail Flick before and after application of TENS for comparing the change of pain. The administration of yohimbine or propranolol at a dose of 3 mg/kg was effective in antagonizing the analgesia induced by high (150 Hz) and low (10 Hz) frequency transcutaneous electric nerve stimulation according to ANOVA test followed by Duncan post hoc test (p<0.05). Thus, it is suggested the involvement of alpha-2 and beta noradrenergic receptors in the modulation of transcutaneous electric nerve stimulation-induced analgesia.

La estimulación eléctrica nerviosa transcutánea es un método no invasivo utilizado en la clínica de Fisioterapia para controlar el dolor agudo y crónico. Diversas teorías son propuestas para explanar el mecanismo de acción analgésico de la estimulación eléctrica nerviosa transcutánea, como la participación de neurotransmisores centrales y periféricos. El objetivo del presente estudio fue evaluar la participación de la vía noradrenérgica y de los receptores alfa-2 y beta en la modulación de analgesia inducida por la estimulación eléctrica nerviosa transcutánea con alta y baja frecuencia en ratos del tipo Wistar, después del tratamiento crónico con yohimbina o propranolol por la vía intraperitoneal. Animales que pesaban 200 y 300 g fueron divididos en nueve grupos (n=8), por los cuales fueron obtenidos los umbrales nociceptivos por medio del Tail Flick, antes y después de la aplicación de la estimulación eléctrica nerviosa transcutánea con el intuito de comparar la alteración del cuadro álgico. La administración de yohimbina o propranolol en el dosis de 3 mg/kg fue eficaz en resultar en una antagonización de analgesia inducida por la estimulación eléctrica nerviosa transcutánea con alta (150 Hz) y baja (10 Hz) frecuencia, de acuerdo al test de ANOVA seguido del test post-hoc de Duncan (p>0,05). Por lo tanto, se sugiere el envolvimiento de los receptores noradrenergicos alfa-2 y beta en la modulación de analgesia inducida por la estimulación eléctrica nerviosa transcutánea.

Estimulação elétrica nervosa transcutânea é um método não invasivo utilizado na clínica de Fisioterapia para controlar dores aguda ou crônica. Diferentes teorias são propostas para explicar o mecanismo de ação analgésica da estimulação elétrica nervosa transcutânea, como a participação de neurotransmissores centrais e periféricos. O objetivo do presente estudo foi avaliar a participação da via noradrenérgica e dos receptores alfa-2 e beta na modulação da analgesia induzida pela estimulação elétrica nervosa transcutânea de alta e baixa frequência em ratos Wistar, após tratamento crônico com ioimbina ou propranolol por via intraperitoneal. Animais pesando entre 200 e 300 g foram divididos em 9 grupos (n=8), dos quais se obteve os limiares nociceptivos por meio do Tail Flick antes e após a aplicação da estimulação elétrica nervosa transcutânea para comparação de mudança do quadro álgico. A administração de ioimbina ou de propranolol na dose de 3 mg/kg foi efetiva em causar uma antagonização da analgesia induzida pela estimulação elétrica nervosa transcutânea de alta (150 Hz) e baixa frequência (10 Hz) segundo teste ANOVA seguido do teste post hoc Duncan (p<0,05). Dessa forma, sugere-se o envolvimento de receptores noradrenérgicos alfa-2 e beta na modulação da analgesia induzida pela estimulação elétrica nervosa transcutânea. .