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1.
Medicine (Baltimore) ; 99(23): e20301, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501976

RESUMO

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication after surgery. However, drugs cannot prevent it completely, and acupuncture therapy shows the potential in preventing PONV, yet the best choice hasn't been demonstrated. OBJECTIVE: This network meta analysis aimed to evaluate the effectiveness of different acupuncture therapies used for preventing PONV in abdominal operation. METHODS: Authors searched articles from PubMed/Medline, Cochrane library, Web of Science, Ebsco and Ovid/Embase, and established database from setup time to June 2019. Quality evaluation of included studies was performed with Cochrane risk-of-bias tool (ROB 2.0). Pairwise and network meta analysis were conducted by RevMan and Addis respectively. RESULTS: Twenty studies with 2862 patients were included in this research. Pairwise meta analysis shows that compared with placebo, transcutaneous electric nerve stimulation had lower risk of postoperative nausea (PON) (odds ratio (OR) = 0.42, 95%confidence interval (CI): 0.30-0.60), postoperative vomiting (POV) (OR = 0.53, 95%CI: 0.36-0.78), PONVs (OR = 0.46, 95%CI: 0.31-0.68), and postoperative rescue (POR) (OR = 0.61, 95%CI: 0.41-0.90), Capsicum had lower risk of PON (OR = 0.16, 95%CI: 0.09-0.28), PONVs (OR = 0.23, 95%CI: 0.12-0.45), Acupressure had lower risk of POV (OR = 0.42, 95%CI: 0.25-0.70), POR (OR = 0.42, 95%CI: 0.27-0.64). In network meta analysis, compared with usual care, the probability rank suggested that Acupoint Injection showed lowest risk of PON (OR = 0.02, 95%CI: 0.00-0.11), POV (OR = 0.06, 95%CI: 0.01-0.49), Usual care for PONVs (OR = 0.31, 95%CI: 0.13-0.75), and Capsicum for POR (OR = 0.39, 95%CI: 0.07-2.33). Further study should be carried out to verify this result. CONCLUSION: Both pairwise and network meta analysis showed acupuncture therapy was superior to placebo and usual care. Different acupuncture therapy regimens may have advantages in different aspects. And compared with POV, PON seems easier to control. Research results may provide guidance for the prevention of PONV.Systematic review registration: PROSPERO CRD42019147556.


Assuntos
Terapia por Acupuntura/métodos , Náusea e Vômito Pós-Operatórios/terapia , Acupressão/métodos , Antieméticos/uso terapêutico , Teorema de Bayes , Humanos , Metanálise em Rede , Razão de Chances , Náusea e Vômito Pós-Operatórios/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Elétrica Nervosa Transcutânea/métodos
2.
J Electromyogr Kinesiol ; 53: 102437, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32554206

RESUMO

OBJECTIVE: We aimed to specify and quantify the characteristics of the decrement in low-frequency repetitive nerve stimulation response in Lambert-Eaton myasthenia syndrome (LEMS) and compare it to those of myasthenia gravis (MG). PATIENTS AND METHODS: We retrospectively reviewed 18 patients with LEMS and 24 patients with MG. Ten consecutive stimulations were applied at 3 Hz to the abductor pollicis brevis. We determined the position of the smallest wave in the stimulation sequence, and we calculated the decrement and recovery. RESULTS: The median sequential order of the minimum wave was 8 in the LEMS group and 5 in the MG group (p < 0.001). The median decrement in the LEMS group was 36.7%, while that in the MG group was 21.0% (p = 0.047). The recovery percentage was 1.4% in the LEMS group and 3.5% in the MG group (p = 0.001). The area under the curve for the sequential order of the minimum wave was 0.90, and the reciprocal optimum cut-off point was 6.5. CONCLUSIONS: We elucidated a pattern with a delayed nadir and subsequent poor recovery, featuring a low-frequency decrement; furthermore, we determined the most likely sequential order of the minimum wave in patients with LEMS, and the indicator was useful for differentiation.


Assuntos
Eletromiografia/métodos , Síndrome Miastênica de Lambert-Eaton/diagnóstico , Síndrome Miastênica de Lambert-Eaton/fisiopatologia , Músculo Esquelético/fisiopatologia , Exame Neurológico/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Idoso , Algoritmos , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Pain Physician ; 23(3): 253-262, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517391

RESUMO

BACKGROUND: Meralgia paresthetica (MP) is an entrapment mononeuropathy of the lateral femoral cutaneous nerve (LFCN), in which conservative treatment options are not always sufficient. OBJECTIVES: The aim of this study was to evaluate the efficacy of ultrasound (US)-guided LFCN injection in the management of MP by comparing with transcutaneous electrical nerve stimulation (TENS) therapy and sham TENS therapy. STUDY DESIGN: A prospective, randomized, sham-controlled study. SETTING: Health Sciences University Training and Research Hospital in Turkey. METHODS: Patients diagnosed with LFCN compression with clinical and electrophysiological findings were included in this study. Patients were randomly assigned to 3 groups: (1) US-guided injection group, (2) TENS group, and (3) sham TENS group. The blockage of the LFCN was performed for therapeutic MP management in group 1. Ten sessions of conventional TENS were administered to each patient 5 days per week for 2 weeks, for 20 minutes per daily session in group 2, and sham TENS was applied to group 3 with the same protocol. Visual Analog Scale (VAS), painDETECT questionnaire, Semmes-Weinstein monofilament test (SWMt), Pittsburgh Sleep Quality Index (PSQI), and health-related quality of life (36-Item Short Form Health Survey [SF-36]) at onset (T1), 15 days after treatment (T2), and 1 month after treatment (T3) were used for evaluation. Patients and the investigator who evaluated the results were blinded to the treatment protocol during the study period. RESULTS: A total of 54 of the 62 patients (group 1 n = 17, group 2 n = 16, group 3 n = 21) completed the study, 3 patients from group 1, 4 patients from group 2, and 1 patient from group 3 dropped out during the follow-up period. The mean changes in painDETECT and SWMt scores showed a statistically significant difference between groups in favor of group 1 at T2 and T3 compared with T1 (P < 0.05). There was no statistically significant difference between groups in terms of VAS, SF-36, and PSQI scores (P > 0.05). In-group analysis of VAS scores showed a statistically significant decrease in T2 and T3 compared with T1 in group 1 (P < 0.05). In-group analysis of the VAS scores statistically significant decrease was shown in T2 compared with T1 in group 2 (P < 0.05). In-group analysis of painDETECT scores statistically significant decrease was shown in T2 and T3 compared with T1 in all groups (P < 0.05). In-group analysis of SWMt scores statistically significant decrease was shown in T2 and T3 compared with T1 in group 1 (P < 0.05). In-group analysis of SF-36 and PSQI scores, there was no statistically significant decrease in all groups (P > 0.05). LIMITATIONS: The limitation of the study was a short follow-up period. CONCLUSIONS: US-guided LFCN injection and TENS may be therapeutic options for MP treatment, however, for patients with neuropathic pain symptoms, US-guided LFCN injection may be a safe and alternative method to conservative treatment. KEY WORDS: Meralgia paresthetica, ultrasound-guided injection, transcutaneous electrical nerve stimulation.


Assuntos
Anestésicos Locais/uso terapêutico , Neuropatia Femoral/terapia , Glucocorticoides/uso terapêutico , Bloqueio Nervoso/métodos , Adulto , Betametasona/análogos & derivados , Betametasona/uso terapêutico , Tratamento Conservador/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prilocaína/uso terapêutico , Estudos Prospectivos , Qualidade de Vida , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Turquia , Ultrassonografia de Intervenção
5.
Medicine (Baltimore) ; 99(19): e20149, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384502

RESUMO

INTRODUCTION: Chemotherapy-induced peripheral neuropathy (CIPN) is a worldwide concern in patients receiving neurotoxic agents for cancer therapy. High tone external muscle stimulation is a promising therapeutic approach to alleviate symptoms of CIPN. METHODS: This pilot study aims to investigate whether the application of home-based high-tone external muscle stimulation therapy (HTEMS) improves symptoms of CIPN. The trial is planned as a therapist- and assessor-blinded, 1:1 randomized controlled study. A total of 50 patients with chemotherapy-induced peripheral polyneuropathy will be included. All patients will perform therapy at home. Study participants will be allocated randomly to the HTEMS therapy (intervention group) or to the transcutaneous electrical nerve stimulation (TENS, control group), respectively, following a standardized therapy schedule. Compliance of participants can be verified by reading out the tool box. Outcomes will be evaluated at baseline and after 8 weeks of home-based therapy. The primary outcome includes improvement of CIPN according to the patient-reported EORTC QLQ-CIPN 20 questionnaire. Secondary outcomes are the patient-reported change in health-related quality of life and clinician-reported changes of vibration sensibility, tendon reflexes, temperature sensibility, perception of touch, and strength of the lower leg muscles. Further a safety- and process evaluation will be performed. DISCUSSION: This pilot RCT aims to evaluate the impact of home-based HTEMS as compared to TENS in CIPN. There is a need for an effective treatment for CIPN and the results of this study are expected to possibly identify a novel and effective treatment strategy in the future.


Assuntos
Antineoplásicos/efeitos adversos , Polineuropatias/induzido quimicamente , Polineuropatias/terapia , Autocuidado/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Pesos e Medidas Corporais , Fumar Cigarros/epidemiologia , Método Duplo-Cego , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Cooperação do Paciente , Projetos Piloto , Qualidade de Vida , Reflexo de Estiramento , Projetos de Pesquisa , Índice de Gravidade de Doença , Fatores Sexuais , Sensação Térmica , Tato , Adulto Jovem
6.
Am Fam Physician ; 101(11): 654-664, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32463642

RESUMO

Procedural anesthesia is administered by family physicians for a variety of conditions, including neuropathies, fracture reduction, foreign body removals, and complex wound management. A nerve block may be preferred because it provides effective regional anesthesia with less anesthetic. Nerve blocks require a thorough understanding of relevant anatomy, aiding the physician in optimizing the anesthesia effect while minimizing complications. Nerve blocks can be guided by bony landmarks, peripheral nerve stimulation, or ultrasonography. Ultrasound-guided nerve blocks are superior in decreasing procedural complications and procedure time. Physicians should be aware of these techniques to appropriately counsel their patients on procedural options. Nerve blocks of the ulnar, median, and radial nerves at the wrist and elbow provide effective anesthesia for a wide range of medical procedures in the upper extremity.


Assuntos
Bloqueio Nervoso/métodos , Extremidade Superior/lesões , Humanos , Estimulação Elétrica Nervosa Transcutânea/métodos , Ultrassonografia/métodos , Extremidade Superior/anatomia & histologia , Extremidade Superior/fisiopatologia
8.
Neurology ; 94(18): e1900-e1907, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32269109

RESUMO

OBJECTIVE: To determine whether Scrambler therapy is an effective, acceptable, and feasible treatment of persistent central neuropathic pain in patients with neuromyelitis optica spectrum disorder (NMOSD) and to explore the effect of Scrambler therapy on co-occurring symptoms. METHODS: We conducted a randomized single-blind, sham-controlled trial in patients with NMOSD who have central neuropathic pain using Scrambler therapy for 10 consecutive weekdays. Pain severity, pain interference, anxiety, depression, and sleep disturbance were assessed at baseline, at the end of treatment, and at the 30- and 60-day follow-up. RESULTS: Twenty-two patients (11 per arm) were enrolled in and completed this trial. The median baseline numeric rating scale (NRS) pain score decreased from 5.0 to 1.5 after 10 days of treatment with Scrambler therapy, whereas the median NRS score did not significantly decrease in the sham arm. Depression was also reduced in the treatment arm, and anxiety was decreased in a subset of patients who responded to treatment. These symptoms were not affected in the sham arm. The safety profiles were similar between groups. CONCLUSIONS: Scrambler therapy is an effective, feasible, and safe intervention for central neuropathic pain in patients with NMOSD. Decreasing pain with Scrambler therapy may additionally improve depression and anxiety. CLINICALTRIALSGOV IDENTIFIER: NCT03452176. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that Scrambler therapy significantly reduces pain in patients with NMOSD and persistent central neuropathic pain.


Assuntos
Neuralgia/terapia , Neuromielite Óptica/complicações , Neuromielite Óptica/terapia , Manejo da Dor/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/etiologia , Método Simples-Cego
9.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(3): 179-185, mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-188146

RESUMO

Introducción: Los pacientes con obesidad, con frecuencia, tienen dificultad para adherirse a una dieta baja en calorías durante largos períodos de tiempo. Una de las causas del fracaso dietético es la sensación continua de hambre. La grelina es un péptido orexígeno, secretado por células enterocromafines del fundus gástrico. El objetivo de este estudio fue analizar las variaciones de los valores plasmáticos de grelina tras PENS del dermatoma T6 asociado a dieta hipocalórica, así como la modificación del apetito y la pérdida de peso, comparándolo con un grupo control en el que solo se pautó una dieta hipocalórica. Material y métodos: Realizamos un estudio prospectivo no aleatorizado, incluyendo 20 pacientes sometidos a PENS del dermatoma T6, asociado a dieta hipocalórica, como tratamiento previo a ser sometidos a una técnica de cirugía bariátrica y con el fin de reducir peso (grupo 1), y 20 pacientes a los que se les pautó exclusivamente dieta hipocalórica previa a la intervención quirúrgica (grupo 2). En el grupo 1 se analizaron los niveles de grelina plasmática en 5 momentos diferentes del procedimiento: antes de realizar la primera sesión de PENS (muestra 1a), al finalizar la primera sesión de PENS (muestra 1b), antes de realizar la última sesión de PENS (muestra 2a), al finalizar la última sesión de PENS (muestra 2b) y un mes después de haber finalizado el tratamiento (muestra 3). En el grupo 2 se obtuvieron solo 2 muestras, antes de comenzar la dieta (muestra 1) y tras 12 semanas de dieta (muestra 2). Resultados: Tras 12 semanas de tratamiento se observó una pérdida de IMC del 8,42 ± 2,6% en el grupo 1 y del 1,32 ± 0,98% en el grupo 2 (p = 0,007). En el grupo 1 se apreció un descenso significativo de los valores de grelina entre las muestras 1a y 2a, y entre las muestras 1a y 3. En el grupo 2 se observó un aumento no significativo de los niveles de grelina entre las muestras 1 y 2. Conclusión: El PENS del dermatoma T6 se asoció con una disminución en los valores de grelina plasmática. Esta terapia, asociada a una dieta hipocalórica, consigue una pérdida de IMC superior al 8% en 12 semanas de tratamiento


Introduction: Obese patients often find it difficult to adhere to long-term low-calorie diets. One of the reasons for dietary failure is the permanent feeling of hunger. Ghrelin is an orexigenic hormone, secreted by enterochromaffin cells in the gastric fundus. The aim of this study was to analyze changes in plasma ghrelin levels after PENS of dermatome T6 associated to a low-calorie diet, as well as changes in appetite and weight loss, as compared to a control group on a low-calorie alone. Material and methods: A prospective, non-randomized study was conducted including 20 patients who underwent PENS of dermatome T6 associated to a low-calorie diet before undergoing bariatric surgery to lose weight (Group 1), and 20 patients who were only prescribed a low-calorie diet before surgery (Group 2). In Group 1, plasma ghrelin levels were measured at 5 timepoints: before the first PENS session (Sample 1a); after the first PENS session (Sample 1b); before the last PENS session (Sample 2a); after the last PENS session (Sample 2b); and one month after treatment completion (Sample 3). In Group 2, only two samples were collected: before the start of the diet (Sample 1) and after 12 weeks of diet (Sample 2). Results: After 12 weeks of treatment, BMI decreases of 8.42% ± 2.6% and 1.32% ± 0.98% were seen in Group 1 and Group 2 respectively (p = 0.007). A significant decrease was seen in ghrelin levels between samples 1a and 2a, and between samples 1a and 3. In Group 2, a non-significant increase was seen in ghrelin levels. Conclusion: PENS of dermatome T6 was associated to decreased plasma ghrelin levels. This therapy, associated to a low-calorie diet, achieves a BMI reduction greater than 8% after 12 weeks of treatment


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Grelina/uso terapêutico , Estimulação Elétrica Nervosa Transcutânea/métodos , Obesidade/terapia , Regulação do Apetite , Dieta Redutora , Grelina/metabolismo , Perda de Peso , Estudos Prospectivos , Índice de Massa Corporal , Dieta Mediterrânea , Grelina/sangue , Análise de Variância , Antropometria/métodos
10.
Cochrane Database Syst Rev ; 3: CD012762, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32124977

RESUMO

BACKGROUND: Sickle cell disease (SCD), one of the most common inherited disorders, is associated with vaso-occlusive pain episodes and haemolysis leading to recurrent morbidity, hospital admissions and work or school absenteeism. The crises are conventionally treated with opioids, non-opioids and other adjuvants with the risk of developing complications, addictions and drug-seeking behaviour. Different non-pharmacological treatments, such as transcutaneous electrical nerve stimulation (TENS) have been used for managing pain in other painful conditions. Hence, the efficacy of TENS for managing pain in SCD needs to be reviewed. OBJECTIVES: To assess the benefits and harms of TENS for managing pain in people with SCD who experience pain crises or chronic pain (or both). SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Register, comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also searched online trial registries and the reference lists of relevant articles and reviews. Date of the last search: 26 Febraury 2020. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs, where TENS was evaluated for managing pain in people with SCD. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility of the trials identified by the literature searches according to the inclusion criteria. Two review authors then independently extracted data, assessed for risk of bias using the Cochrane standard tool and rated the quality of evidence using the GRADE guidelines. MAIN RESULTS: One double-blind cross-over RCT with 22 participants with SCD (aged 12 to 27 years) was eligible for inclusion. Following stratification into four pain crises severity grades, participants were then randomised to receive TENS or placebo (sham TENS). The trial was concluded after 60 treatment episodes (30 treatment episodes of each treatment group). There is a lack of clarity regarding the trial design and the analysis of the cross-over data. If a participant was allocated to TENS treatment for an episode of pain and subsequently returned with a further episode of a similar degree of pain, they would then receive the sham TENS treatment (cross-over design). For those experiencing a pain episode of a different severity, it is not clear whether they were re-randomised or given the alternate treatment. Reporting and analysis was based on the total number pain events and not on the number of participants. It is unclear how many participants were crossed over from the TENS group to the sham TENS group and vice versa. The trial had a high risk of bias regarding random sequence generation and allocation concealment; an unclear risk regarding the blinding of participants and personnel; and a low risk regarding the blinding of the outcome assessors and selective outcome reporting. The trial was small and of very low quality; furthermore, given the issue with trial design we were unable to quantitatively analyse the data. Therefore, we present only a narrative summary and caution is advised in interpreting the results. In relation to our pre-defined primary outcomes, the included trial did not report pain relief at two to four weeks post intervention. The trial authors reported that no difference was found in the changes in pain ratings (recorded at one hour and four hours post intervention) between the TENS and the placebo groups. In relation to our secondary outcomes, the analgesic usage during the trial also did not show any difference between groups. Given the quality of the evidence, we are uncertain whether TENS improves overall satisfaction as compared to sham TENS. The ability to cope with activities of daily living was not evaluated. Regarding adverse events, although one case of itching was reported in the TENS group, the site and nature of itching was not clearly stated; hence it cannot be clearly attributed to TENS. Also, two participants receiving 'sham' TENS reported a worsening of pain with the intervention. AUTHORS' CONCLUSIONS: Since we have only included one small and very low-quality trial, with a high risk of bias across several domains, we are unable to conclude whether TENS is harmful or beneficial for managing pain in people with SCD. There is a need for a well-designed, adequately-powered, RCT to evaluate the role of TENS in managing pain in people with SCD.


Assuntos
Dor Crônica/terapia , Manejo da Dor/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Analgésicos/uso terapêutico , Anemia Falciforme/fisiopatologia , Dor Crônica/etiologia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
J Acupunct Meridian Stud ; 13(3): 83-86, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32198095

RESUMO

BACKGROUND AND OBJECTIVES: Needle insertion pain during spinal anesthesia is an unpleasant experience for patients. This study aimed to investigate the effects of Transcutaneous Electrical Nerve Stimulation (TENS) on the pain intensity during the insertion of spinal needles in patients undergoing spinal anesthesia. MATERIALS AND METHODS: In a double-blind clinical trial, 60 candidates for elective Trans Ureteral Lithotripsy surgery under spinal anesthesia were randomly divided into intervention and control groups. The electrodes of the TENS device were placed in the space between L3-L4 and L5-S1 vertebrae. The intensity of pain during insertion of the spinal needle by Visual Analog Scale and the frequency of attempts were recorded. RESULTS: The mean age of the study samples was 34.26 ± 5.07 and 32.8 ± 5.28 in the control and intervention group, respectively. The pain intensity during insertion of spinal needles was less significant in the intervention group compared to the control group (p = 0.001). The number of attempts to insert the spinal needle between the two groups was not statistically significant (p = 0.51). The duration of spinal anesthesia implementation procedure by physician in the intervention group was significantly shorter than that of the control group (p = 0.001). CONCLUSION: The use of TENS effectively reduced the pain of spinal needle insertion. Considering these beneficial effects, it is suggested that this procedure be used to relive pain in patients with spinal anesthesia.


Assuntos
Analgesia por Acupuntura/métodos , Raquianestesia/métodos , Medição da Dor/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Analgesia por Acupuntura/instrumentação , Adulto , Raquianestesia/instrumentação , Método Duplo-Cego , Feminino , Humanos , Masculino , Agulhas , Estimulação Elétrica Nervosa Transcutânea/instrumentação
12.
Plast Reconstr Surg ; 145(6): 1427-1438, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195859

RESUMO

BACKGROUND: High-intensity focused ultrasound (HIFU) lipolysis still lacks treatment efficacy. The authors hypothesized that electrical stimulation of muscular groups can enhance the metabolism of free lipids released from HIFU-ablated adipocytes. METHODS: Five-month-old, male Landrace swine, with an average initial weight of 95 kg, were divided randomly into sham, HIFU only, HIFU plus electrical stimulation I, and HIFU plus electrical stimulation II groups. Subcutaneous adipose tissue of the porcine abdomen was treated once by HIFU on days 1 of weeks 1, 3, and 5, and electrical stimulation of the quadriceps was performed once on the day 1 of weeks 1 through 6. The numbers of ultrasonic sonications were 70 per treatment for the HIFU-only and HIFU plus electrical stimulation I groups and 400 for the HIFU plus electrical stimulation II group. The measured data are expressed as medians (ranges). RESULTS: The body weights of all pigs increased gradually with time. The waist circumferences below the sheath decreased from 97.7 ± 6.0 cm in week 1 and 97.9 ± 5.3 cm in week 3 to 96.4 ± 10.0 cm in week 6, and from 105.3 ± 5.1 cm and 101.2 ± 7.4 cm to 100.5 ± 6.1 cm for the HIFU plus electrical stimulation I and II groups, respectively, whereas they increased for the sham and HIFU-only groups. The reductions in the adipose tissue thickness were 0.59, 1.46, and 2.18 mm for the HIFU-only, HIFU plus electrical stimulation I, and HIFU plus electrical stimulation II groups, respectively, when the sham group increased by 1.42 mm. Follow-up blood analyses demonstrated no significant changes in lipid panel parameters from baseline values. CONCLUSION: HIFU plus electrical stimulation can induce a substantial reduction in the waist circumference of pigs.


Assuntos
Contorno Corporal/métodos , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Gordura Subcutânea Abdominal/efeitos da radiação , Estimulação Elétrica Nervosa Transcutânea/métodos , Animais , Terapia Combinada/métodos , Masculino , Modelos Animais , Sus scrofa , Circunferência da Cintura/efeitos da radiação
13.
Cell ; 181(1): 115-135, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32220309

RESUMO

Techniques for neuromodulation serve as effective routes to care of patients with many types of challenging conditions. Continued progress in this field of medicine will require (1) improvements in our understanding of the mechanisms of neural control over organ function and (2) advances in technologies for precisely modulating these functions in a programmable manner. This review presents recent research on devices that are relevant to both of these goals, with an emphasis on multimodal operation, miniaturized dimensions, biocompatible designs, advanced neural interface schemes, and battery-free, wireless capabilities. A future that involves recording and modulating neural activity with such systems, including those that exploit closed-loop strategies and/or bioresorbable designs, seems increasingly within reach.


Assuntos
Materiais Biocompatíveis/uso terapêutico , Sistema Nervoso , Próteses e Implantes , Animais , Humanos , Estimulação Elétrica Nervosa Transcutânea/métodos
14.
Complement Ther Med ; 49: 102295, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147037

RESUMO

The aim of the study was to compare the effect of high-intensity laser therapy (HILT) and a combination of transcutaneous nerve stimulation (TENS) and ultrasound (US) treatment on pain, range of motion (ROM) and functional activity on cervical pain associated with cervical disc herniation (CDH). A total of 40 patients (22 women and 18 men) affected by CDH were enrolled in this study. Patients were randomly divided into two groups. In group 1 (20 subjects), patients received 20 sessions of HILT plus exercise, while in group 2 (20 subjects), a combination of US, TENS and exercise were applied. The outcomes were cervical segment ROM, pain level measured by visual analogue scale (VAS), and functional activity measured by neck pain and disability scale (NPADS) before and after the therapy. The level of statistical significance was set as p < 0.05. There was no difference for cervical ROM, VAS and NPADS values between the groups at the baseline (p> 0.05). After the treatment, cervical ROM, VAS and NPADS values were significantly improved in both groups (p < 0.05). When the groups were compared in terms of post treatment VAS, NPADS and ROM values, no statistical significance was found between the two groups (p> 0.05). Both of therapeutic modalities demonstrated analgesic efficacy and improved the function in patients affected by CDH after 4 weeks of therapy (total 20 treatment sessions in 5 days a week). Both the HILT plus exercise program and the TENS / US plus exercise program were found to be effective in improving cervical range of motion and quality of life by reducing pain. These two treatment programs have similar effects in the treatment of cervical pain associated with CDH and can be used as an alternative to each other in clinical applications. However; It is clear that futher studies are needed to investigate the principles of application of HILT to painful areas or tissues (amount of area applied, dose applied, energy delivered, number of pulses, duration of session, frequency of sessions) and to exclude the effects of exercise treatment on the results of both treatment groups.


Assuntos
Deslocamento do Disco Intervertebral/terapia , Terapia a Laser/métodos , Cervicalgia/terapia , Manejo da Dor/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Terapia por Ultrassom/métodos , Adolescente , Adulto , Terapia Combinada , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular , Método Simples-Cego , Adulto Jovem
15.
Pain Pract ; 20(5): 522-533, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32145131

RESUMO

OBJECTIVE: To identify variables that influence pain reduction following peripheral nerve field stimulation (PNFS) in order to identify a potential responder profile. METHODS: Exploratory univariate and multivariate (random forest) analyses were performed separately on 2 randomized controlled trials and a registry; all included patients with chronic back pain, mainly failed back surgery syndrome. An international expert panel judged the clinical relevance of variables to identify responders by consensus. RESULTS: Variables identified that may help predict PNFS success in patients with back pain include patient and pain characteristics (age, time since onset of pain and spinal surgery, pain medication history, position and size of pain area, pain severity, mixed nociceptive/neuropathic pain, health-related quality of life, depression, functional disability, and leg pain status), implant procedure variables (the number and position of leads, paresthesia coverage, and amount of pain relief during the trial), and programming (number of programs, cathodes, and anodes; pulse rate; pulse width; and percentage of device usage). CONCLUSIONS: While these analyses are exploratory and restricted to a limited sample size, they suggest variables that may play a role in predicting a therapeutic response. These results, however, are informative only and should be cautiously interpreted. Future research to validate the variables in a clinical study is needed.


Assuntos
Dor Lombar/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistema de Registros
16.
Support Care Cancer ; 28(11): 5323-5333, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32128614

RESUMO

PURPOSE: Transcutaneous electrical nerve stimulation (TENS) is a treatment option for cancer pain, but the evidence is inconclusive. We aimed to evaluate the efficacy and safety of TENS. METHODS: A blinded, randomized, sham-controlled pilot cross-over trial (NCT02655289) was conducted on an inpatient specialist palliative care ward. We included adult inpatients with cancer pain ≥ 3 on an 11-point numerical rating scale (NRS). Intensity-modulated high TENS (IMT) was compared with placebo TENS (PBT). Patients used both modes according to their preferred application scheme during 24 h with a 24-h washout phase. The primary outcome was change in average pain intensity on the NRS during the preceding 24 h. Responders were patients with at least a "slight improvement." RESULTS: Of 632 patients screened, 25 were randomized (sequence IMT-PBT = 13 and PBT-IMT = 12). Finally, 11 patients in IMT-PBT and 9 in PBT-IMT completed the study (N = 20). The primary outcome did not differ between groups (IMT minus PBT: - 0.2, 95% confidence interval - 0.9 to 0.6). However, responder rates were higher in IMT (17/20 [85%] vs. 10/20 [50%], p = 0.0428). Two patients experienced an uncomfortable feeling caused by the current, one after IMT and one after PBT. Seven patients (35%) desired a TENS prescription. Women and patients with incident pain were most likely to benefit from TENS. CONCLUSION: TENS was safe, but IMT was unlikely to offer more analgesic effects than PBT. Even though many patients desired a TENS prescription, 50% still reported at least "slight pain relief" from PBT. Differences for gender and incident pain aspects demand future trials.


Assuntos
Dor do Câncer/terapia , Neoplasias/terapia , Cuidados Paliativos/métodos , Estimulação Elétrica Nervosa Transcutânea , Adulto , Idoso , Estudos Cross-Over , Progressão da Doença , Feminino , Alemanha , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Manejo da Dor/métodos , Manejo da Dor/normas , Medição da Dor , Cuidados Paliativos/normas , Projetos Piloto , Placebos , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento
17.
Medicine (Baltimore) ; 99(8): e19191, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080103

RESUMO

INTRODUCTION: Chronic neck pain is a common musculoskeletal disorder that is associated with functional disability and decreased of quality of life. Electrophysical agents are commonly used to relieve pain, however the effects of combined use of these agents are little studied. The objective is to investigate the efficacy of photobiomodulation and electrical stimulation to relieve pain, both in isolation and combined. MATERIALS AND METHODS: This a 4-arm randomized placebo-controlled trial with patient and evaluator blinded. This study will be performed in Department of Physical Therapy at Federal University of São Carlos, São Carlos/SP, Brazil. One hundred and forty-four patients with chronic neck pain will be randomized into 4 groups: active photobiomodulation therapy with active electrical stimulation, active photobiomodulation therapy, active electrical stimulation, or placebo treatment. They will receive 10 sessions of treatment. PRIMARY OUTCOME: pain intensity (measured by pain numerical rating scale) posttreatment. SECONDARY OUTCOMES: pain during movement, neck disability, range of motion, pressure pain threshold, temporal summation, conditioned pain modulation, depressive symptoms, pain catastrophizing, quality of life, analgesic intake, and global perceived effect at posttreatment (10 sessions). Pain intensity and global perceived effect will also be measured after 6 weeks randomization. DISCUSSION: The findings of this study might clarify the importance of using the photobiomodulation therapy and transcutaneous electrical nerve stimulation for patients with chronic neck pain. TRIAL REGISTRATION: NCT04020861. https://clinicaltrials.gov/ct2/show/NCT04020861?term=NCT04020861&draw=2&rank=1.


Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Cervicalgia/terapia , Modalidades de Fisioterapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adolescente , Adulto , Idoso , Analgésicos/administração & dosagem , Dor Crônica , Terapia Combinada , Depressão/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/epidemiologia , Medição da Dor , Qualidade de Vida , Amplitude de Movimento Articular , Adulto Jovem
18.
J Neuroeng Rehabil ; 17(1): 22, 2020 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-32075666

RESUMO

BACKGROUND: High frequency alternating current (HFAC) stimulation have been shown to produce a peripheral nerve conduction block. Currently, all the studies applying HFAC stimulation in clinical studies, have employed frequencies below 10 kHz. The main aim of this work was to investigate the neuromodulatory effect of transcutaneous 20 kHz stimulation on somatosensory and pain thresholds, and maximal handgrip strength. METHODS: A randomized, crossover, single-blinded, placebo-controlled trial was conducted following recruitment of fourteen healthy volunteers. Transcutaneous stimulation at 20 kHz and sham stimulation were applied over the ulnar and median nerves of fourteen healthy volunteers for 20 min. Maximal handgrip strength (MHS), mechanical detection threshold (MDT) and pressure pain threshold (PPT) were registered prior to, during (15 min), immediately after the end (20 min), and 10 min following stimulation. RESULTS: The 20 kHz stimulation showed a lower MHS during the stimulation at the 15 min (30.1 kgs SE 2.8) and at 20 min (31.8 kgs, SE 2.8) when compared to sham stimulation (35.1 kgs, SE 3.4; p < 0.001 and 34.2 kgs, SE 3.4; p = 0.03, respectively). The 20 kHz stimulation resulted in a slight increase in MDT at 15 min (0.25 mN; 0.25-2.00) when compared to the sham stimulation (0.25 mN; 0.25-0.25; p = 0.02), and no effects were showed for PPT. CONCLUSIONS: High-frequency stimulation at 20 kHz suggests a partial block of nerve activity. Studies in subjects with neurological disorders characterized by nerve hyperactivity are needed to confirm the clinical impact of this non-invasive electrical stimulation technique. TRIAL REGISTRATION: NCT, NCT02837458. Registered on 12 April 2017.


Assuntos
Força da Mão/fisiologia , Limiar Sensorial/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Estudos Cross-Over , Feminino , Voluntários Saudáveis , Humanos , Masculino , Manejo da Dor/métodos , Nervos Periféricos/fisiologia , Adulto Jovem
19.
Sci Rep ; 10(1): 1529, 2020 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-32001763

RESUMO

Inhibiting fear-related thoughts and defensive behaviors when they are no longer appropriate to the situation is a prerequisite for flexible and adaptive responding to changing environments. Such inhibition of defensive systems is mediated by ventromedial prefrontal cortex (vmPFC), limbic basolateral amygdala (BLA), and brain stem locus-coeruleus noradrenergic system (LC-NAs). Non-invasive, transcutaneous vagus nerve stimulation (tVNS) has shown to activate this circuit. Using a multiple-day single-cue fear conditioning and extinction paradigm, we investigated long-term effects of tVNS on inhibition of low-level amygdala modulated fear potentiated startle and cognitive risk assessments. We found that administration of tVNS during extinction training facilitated inhibition of fear potentiated startle responses and cognitive risk assessments, resulting in facilitated formation, consolidation and long-term recall of extinction memory, and prevention of the return of fear. These findings might indicate new ways to increase the efficacy of exposure-based treatments of anxiety disorders.


Assuntos
Extinção Psicológica/fisiologia , Medo/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adolescente , Adulto , Tonsila do Cerebelo/fisiologia , Condicionamento Clássico/fisiologia , Medo/psicologia , Feminino , Humanos , Inibição Psicológica , Masculino , Memória/fisiologia , Córtex Pré-Frontal/fisiologia , Reflexo de Sobressalto/fisiologia , Nervo Vago/metabolismo , Nervo Vago/fisiologia , Estimulação do Nervo Vago/métodos , Adulto Jovem
20.
Cir. pediátr ; 33(1): 30-35, ene. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186135

RESUMO

Introducción: La electroneuroestimulación vesical o TENS (transcutaneous electrical nerve stimulation) ha surgido como nueva alternativa en el manejo de las disfunciones del tracto urinario inferior. Nuestro objetivo fue evaluar la eficacia y seguridad de esta terapia en niños con diagnóstico de vejiga hiperactiva. Material y métodos. Estudio prospectivo de pacientes con diagnóstico de vejiga hiperactiva tratados con electroneuroestimulación. La terapia con TENS domiciliario se mantuvo durante 6 meses. Evaluamos la severidad de la sintomatología urinaria utilizando el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score). Resultados: Un total de 21 pacientes (13 niñas) fueron incluidos en el estudio, con una edad media de 10 años (Rango: 6-16). Los síntomas más frecuentes fueron: incontinencia (89%) y urgencia (100%). Encontramos diferencias estadísticamente significativas (p< 0,05) en los valores medios del PLUTSS antes de iniciar tratamiento y al finalizar el mismo: PLUTSS inicial 17,8 (Rango: 10-29), a los 3 meses: 7,21 (Rango: 2-16), a los 6 meses: 5,6 (Rango: 3-12). El volumen miccional máximo de todos los pacientes aumentó a los 6 meses de tratamiento. Todos los pacientes sintieron una mejora en su calidad de vida al finalizar el estudio. Conclusiones: La terapia con TENS domiciliario parece una opción segura y eficaz en el manejo de la vejiga hiperactiva, sin embargo, deben ser realizados más estudios randomizados para demostrar su efectividad y protocolizar su aplicación en los pacientes en edad pediátrica


Introduction: In recent years, TENS (Transcutaneous Electrical Nerve Stimulation) bladder electroneurostimulation has emerged as a new alternative in the management of lower urinary tract dysfunctions. Our objective was to evaluate the efficacy and safety of this therapy in children with overactive bladder. Materials and methods: Prospective study of patients diagnosed with overactive bladder and treated with electroneurostimulation. The system was maintained for 6 months. The severity of urinary symptoms was assessed using the PLUTSS (Pediatric Lower Urinary Tract Scoring System) questionnaire. Results: A total of 21 patients were included in the study, with an average age of 10 years (range: 6-16). The most frequent symptoms were incontinence (89%) and urgency (100%). Statistically significant differences (p<0.05) in mean PLUTSS scores between treatment initia-tion and treatment completion were found: PLUTSS was 17.8 (range: 10-29) at baseline, 7.21 (range: 2-16) at month 3, and 5.6 (range: 3-12) at month 6. The maximum voiding volume of all patients increased after 6 months of treatment. All patients had their quality of life improved at the end of the study. Conclusions: Home TENS therapy is a safe and effective option in the management of overactive bladder in the pediatric population. However, further randomized studies should be carried out to pro-tocolize and clarify the effectiveness of this therapeutic approach


Assuntos
Humanos , Feminino , Criança , Adolescente , Masculino , Bexiga Urinária Hiperativa/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Serviços de Assistência Domiciliar , Segurança do Paciente , Estudos Prospectivos , Reologia , Inquéritos e Questionários
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