Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.788
Filtrar
1.
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
2.
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
3.
J Urol ; 203(2): 385-391, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31518202

RESUMO

PURPOSE: We investigated efficacy and compliance related to percutaneous tibial nerve stimulation in patients treated for overactive bladder at a large, urban safety net hospital. MATERIALS AND METHODS: Consecutive patients who underwent percutaneous tibial nerve stimulation at Grady Memorial Hospital from May 2015 through January 2019 were included in our cohort and records were reviewed retrospectively. Primary outcomes of interest included self-reported urinary symptoms and episodes of urinary incontinence. Our secondary outcome of interest was patient compliance, defined as completion of 12 or more treatment sessions. Descriptive analysis and paired t-tests were performed. RESULTS: Of the 50 patients with a mean ± SD age of 59 ± 12 years 80% were black, 52% were male, 34% were uninsured and 54% subscribed to government insurance. Prior treatment included behavioral modification in 100% of cases, anticholinergics in 86% and mirabegron in 4%. Patients completed a mean of 10.7 ± 2.7 of the 12 planned weekly percutaneous tibial nerve stimulation treatments. Of the patients 70% completed all 12 weekly treatments and 77% of those who completed 12 treatments continued to maintenance treatment. After percutaneous tibial nerve stimulation treatment average symptoms improved across all metrics, including mean daytime frequency (from 11.0 to 6.6 episodes per day or -24.5%), nighttime frequency (from 4.8 to 2.5 episodes per night or -47.1%), urgency score (from 3.4 to 1.9 or -42.1%) and incontinence (from 1.6 to 0.4 episodes per day or -79.6%) (each p <0.001). A total of 43 patients (86%) reported symptom improvement. CONCLUSIONS: Percutaneous tibial nerve stimulation had favorable efficacy and compliance in a traditionally underserved patient population. This should be considered as a feasible modality to manage overactive bladder symptoms in patients in a similar demographic.


Assuntos
Estimulação Elétrica Nervosa Transcutânea , Bexiga Urinária Hiperativa/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Retrospectivos , Provedores de Redes de Segurança , Nervo Tibial , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento
4.
J Urol ; 203(1): 179-184, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31347949

RESUMO

PURPOSE: We aimed to determine the real world safety and cost of third line overactive bladder therapies, including onabotulinumtoxinA and sacral neuromodulation. MATERIALS AND METHODS: We performed an all-inclusive, population based cohort study of third line therapies of overactive bladder (sacral neuromodulation or onabotulinumtoxinA) using the statewide surgical data captured in the New York Statewide Planning and Research Cooperative System. The main outcome measures were 30-day safety events, and 1 and 3-year health care utilization costs. Propensity score matching was done to control for confounding factors and comparative analyses of safety events were also performed. RESULTS: Our cohort included 2,680 patients, of whom 1,328 underwent sacral neuromodulation and 1,352 received onabotulinumtoxinA from January 1, 2013 through December 31, 2016. Average ± SD age was 61.7 ± 16.3 years and 82.7% of the patients were female. Sacral neuromodulation implantation led to re-intervention in 15.8% of cases within 1 year and in 26.1% at 3 years. In this comparative analysis patients who received onabotulinumtoxinA therapy were at higher risk for urinary tract infection, hematuria, urinary retention and an emergency room visit compared to those treated with sacral neuromodulation. The overall cost of onabotulinumtoxinA was lower than the cost of the sacral neuromodulation device (cost at 1 year $2,896 vs $15,343 and at 3 years $3,454 vs $16,189, each p <0.01). CONCLUSIONS: Sacral neuromodulation implantation was more expensive than onabotulinumtoxinA injection. However, patients who underwent sacral neuromodulation had a lower complication rate than patients treated with onabotulinumtoxinA. A quality improvement collective database must be created to track information on onabotulinumtoxinA and sacral neuromodulation treatment. This would help generate better performance and comparative data for patient and physician decision making.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Estimulação Elétrica Nervosa Transcutânea/métodos , Bexiga Urinária Hiperativa/terapia , Idoso , Toxinas Botulínicas Tipo A/economia , Feminino , Humanos , Plexo Lombossacral , Masculino , Fármacos Neuromusculares/economia , New York , Segurança do Paciente , Pontuação de Propensão , Estimulação Elétrica Nervosa Transcutânea/economia , Bexiga Urinária Hiperativa/economia
5.
Medicine (Baltimore) ; 98(45): e17755, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702626

RESUMO

INTRODUCTION: A vast majority of children with functional constipation respond to the standard medical treatment. However, a subset of patients may present with an unsatisfactory response and only minor improvement of symptoms. Transcutaneous posterior tibial nerve stimulation (PTNS) involves electrical stimulation of the posterior tibial nerve at the level of the ankle, transcutaneously through electrodes fixated on the overlying skin. Stimulation of the tibial nerve can modulate urinary and defecatory function through the stimulation of sacral nerves. Thus, transcutaneous PTNS can be considered a very promising, noninvasive, and safe method to be used in the pediatric age group. However, there is still no published study that has investigated its use in children for the treatment of intestinal constipation. This is a single-center, prospective, longitudinal, and interventional study designed to assess the applicability and clinical outcomes of transcutaneous PTNS in children with functional intestinal constipation. Children will be submitted to daily sessions of transcutaneous PTNS for a period of 4 weeks. All children will also be invited to participate in semistructured interviews, 1 in each of the 3 assessments: 1 week before the start of the intervention; immediately after the 4 weeks of intervention; and 4 weeks after the end of the intervention period. In these interviews, the aspects related to bowel habits and quality of life will be assessed. This project aims to evaluate the clinical outcomes of transcutaneous PTNS in children with functional intestinal constipation and the applicability of this kind of treatment. CONCLUSIONS: This protocol intended to demonstrate the efficacy of this promising method to increase the number of bowel movements and the stool consistency, to reduce the number of episodes of retentive fecal incontinence, and to indirectly improve the overall quality of life.


Assuntos
Constipação Intestinal/terapia , Incontinência Fecal/terapia , Nervo Tibial/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adolescente , Criança , Ensaios Clínicos como Assunto , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Qualidade de Vida , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(45): e17795, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702631

RESUMO

RATIONALE: Overactive bladder (OAB) is a common disease in the female urinary system. Refractory OAB is an indication for sacral neuromodulation (SNM) therapy, which was approved by the Food and Drug Administration (FDA) of the United States. However, SNM does not alleviate the clinical symptoms in all refractory OAB cases. Patients are required to undergo an SNM stage 1 operation, a traumatic and costly procedure, to evaluate the clinical efficacy of the treatment. If the procedure is predicted to likely be ineffective, the patient has to bear the physical and economic losses. Here, we report a patient with a 3-year course of refractory urge urinary incontinence who was treated with electroacupuncture according to traditional Chinese medicine (TCM). PATIENT CONCERNS: The patient was 73 years old and had frequent urination and urge urinary incontinence for 3 years; she had 24 to 30 counts of urination per day and 7 to 9 counts of urge incontinence. The patient was treated with multiple TCM and Western medicines and therapies. The TCM treatment consisted of several patented Chinese medicines and TCM decoctions. The Western medication comprised mainly antibiotics, alpha receptor antagonists, and muscarinic receptor antagonists. The treatment effect was unsatisfactory, and there was no apparent alleviation of symptoms; therefore, she underwent electroacupuncture. DIAGNOSIS: Refractory OAB. INTERVENTIONS: The patient received 30 days of TCM-based electroacupuncture with optimized acupoint positioning, which comprised a total of 10 sessions (1 electroacupuncture session every 2 days) targeting the bilateral Zhongliao and Sanyinjiao acupoints. After treatment, the patient experienced a good therapeutic outcome. OUTCOMES: After 30 days of electroacupuncture treatment, the average daily count of urination in 5 days decreased from 29.3 per day before treatment to 19.8 after treatment, and the average count of urge incontinence decreased from 9.3 before treatment to 5.8 after treatment. However, good prognosis was not stable. After careful consideration, the patient accepted SNM treatment, which greatly alleviated the symptoms of frequent urination and urge incontinence. The patient received follow-up visits for 2 years, during which she manifested stable curative effects. LESSONS: The optimized positioning at the Zhongliao acupoint improves the accuracy of acupuncture. Accurate electroacupuncture alleviates the symptoms of refractory OAB by stimulating the Zhongliao and Sanyinjiao acupoints, as the underlying mechanisms are similar to those of SNM. Therefore, it is possible to use electroacupuncture to estimate the therapeutic effect of SNM, thereby providing a reference for patients and clinicians to determine whether SNM treatment will be effective.


Assuntos
Eletroacupuntura/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Bexiga Urinária Hiperativa/terapia , Pontos de Acupuntura , Idoso , Terapia Combinada , Terapia por Estimulação Elétrica , Feminino , Humanos , Resultado do Tratamento
7.
J Clin Neurophysiol ; 36(6): 437-442, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31688327

RESUMO

Invasive vagus nerve stimulation (VNS) is an approved treatment for drug-resistant epilepsy. Besides recognized clinical efficacy in about 60% of patients, there are major drawbacks such as invasiveness and common side effects including hoarseness, sore throat, shortness of breath, and coughing. Invasive VNS applies electrical stimulation to the left cervical branch of the vagus nerve and excites thick-myelinated afferent nerve fibers. Peripheral vagus nerve afferent volley initiates brainstem activity in the nucleus of the solitary tract and provokes typical brainstem and cerebral activation patterns that mediate the anticonvulsive mode of action. Whereas invasive VNS is an established neuromodulatory treatment in drug-resistant epilepsy, transcutaneous VNS (tVNS) of the auricular branch of the vagus nerve is suggested to be an alternative access path to the same neuronal network without invasiveness. Preclinical and clinical studies indicate that especially the cymba conchae of the auricle is selectively supplied by the auricular branch of the vagus nerve. Recent anatomical data demonstrate existence and quantity of thick-myelinated afferent nerve fibers of the left auricular branch of the vagus nerve that carries 21% of thick-myelinated afferent nerve fibers counted in the left thoracic vagus nerve in humans. Projection of auricular branch of the vagus nerve afferents from the auricle to the nucleus of the solitary tract is known from histochemical and electrophysiological experiments in rodents and confirmed in humans by functional imaging. Cerebral activation patterns triggered by invasive and tVNS resemble each other in appearance. Clinical trials in patients address safety and performance of tVNS and provide evidence for application in drug-resistant epilepsy.


Assuntos
Epilepsia Resistente a Medicamentos/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação do Nervo Vago/métodos , Animais , Epilepsia Resistente a Medicamentos/fisiopatologia , Humanos , Nervo Vago/fisiologia
8.
Medicine (Baltimore) ; 98(46): e18018, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725676

RESUMO

BACKGROUND: Cavus foot is a deformity represented by an increased and rigid medial longitudinal arch, and it is often associated with persistent pain and gait disturbances. None of the conservative conventional treatments for cavus foot have shown conclusive evidence of effectiveness, and so further is research needed to understand how to manage this condition better. This study aimed to assess the immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation of the plantar fascia in adults with idiopathic cavus foot. METHODS: A randomized, single-blinded clinical trial was conducted. Sixty-eight participants with idiopathic cavus foot, as determined by an internal Moreau-Costa-Bertani angle (MCBA) less than 125° in a lateral weight-bearing foot radiograph, were equally distributed into a neuromuscular stretching group (NSG) or a control group (no intervention). The NSG underwent a single session, combining transcutaneous electrical nerve stimulation with static stretching of the plantar fascia. Primary measurements of 3 angles were taken using a lateral weight-bearing foot radiograph: the internal MCBA; the calcaneal pitch angle (CPA); and the first metatarsal declination angle (FMDA). Outcomes were collected at baseline, immediately postintervention, and 1 week after intervention. RESULTS: Analysis of variance revealed a significant group effect for all angles (all, P < .05). NSG participants showed a significant increase in the internal MCBA (P = .03), and a significant decrease in the CPA (P = .01) and FMDA (P = .04) from baseline to immediately postintervention. These changes remained statistically significant 1 week after the intervention (all, P < .05). CONCLUSION: The combination of static stretching and transcutaneous electrical stimulation of the plantar fascia, compared with no treatment, achieved immediate and short-term changes in the internal MCBA, the CPA, and the FMDA, which resulted in flattening the medial longitudinal plantar arch in adults with idiopathic cavus foot.


Assuntos
Exercícios de Alongamento Muscular/métodos , Pé Cavo/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Terapia Combinada , Fáscia/fisiopatologia , Feminino , Humanos , Masculino , Método Simples-Cego , Pé Cavo/diagnóstico por imagem , Suporte de Carga , Adulto Jovem
9.
Clin Interv Aging ; 14: 1607-1614, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31564843

RESUMO

Purpose: The purpose of this study was to evaluate the effects of transcutaneous electrical acupoint stimulation (TEAS) on postoperative autonomic nervous system function and serum biomarkers in the elderly. Patients and methods: A total of 122 American Society of Anesthesiologists class II or III patients with coronary heart disease undergoing spinal surgery were randomly divided into two groups: TEAS (received TEAS at Neiguan [PC6] and Ximen [PC4] for 30 minutes before anesthesia induction until the end of surgery) and control (received electrode plate at the same acupuncture points without any electrical stimulation). Serum was isolated for the measurement of concentration of high-sensitive troponin T (hs-cTnT), CRP, and CK. Heart rate (HR) and heart rate variability (HRV) including: total power (TP), low-frequency (LF) power, high-frequency (HF) power, and LF/HF ratio were used to assess autonomic nervous system function. The primary outcome was to evaluate whether TEAS changed the postoperative serum hs-cTnT. The secondary outcomes were to observe the effects of TEAS on HRV, circulating CK and CRP after surgery. Results: Hs-cTnT, CRP, and CK concentrations were significantly higher on first, third and fifth day after surgery than those before anesthesia induction in both groups. Hs-cTnT concentration was significantly lower on the first and third day after surgery in TEAS group than in control group. Compared with 1 day before surgery, TP, LF, and HF decreased significantly and HR, LF/HF increased significantly on first, third, and fifth day after surgery in control group. Compared with control group, HR was significantly lower on the first, third, and fifth day after surgery, LF/HF decreased and TP, LF, HF were significantly higher on the first day after surgery in TEAS group. Conclusion: TEAS at PC6 and PC4 could reduce postoperative serum hs-cTnT concentration and change HRV index to improve autonomic nervous system activity.


Assuntos
Pontos de Acupuntura , Doença das Coronárias/terapia , Assistência Perioperatória/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Terapia por Acupuntura/métodos , Idoso , Sistema Nervoso Autônomo , Feminino , Frequência Cardíaca , Humanos , Masculino , Estudos Prospectivos
10.
Neurology ; 93(18): e1715-e1719, 2019 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31554650

RESUMO

OBJECTIVE: To report on the benefits of noninvasive vagus nerve stimulation (nVNS) on acute vestibular migraine (VM) treatment. METHODS: This was a retrospective chart review of patients with VM treated with nVNS in a single tertiary referral center between November 2017 and January 2019. Eighteen patients (16 women) were identified (mean age 45.7 [±14.8] years); 14 were treated for a VM attack and 4 for bothersome interictal dizziness consistent with persistent perceptual postural dizziness (PPPD). Patients graded the severity of vestibular symptoms and headache using an 11-point visual analog scale (VAS; 0 = no symptoms, 10 = worst ever symptoms) before and 15 minutes after nVNS. RESULTS: In those with acute VM, vertigo improved in 13/14 (complete resolution in 2, at least 50% improvement in 5). The mean vertigo intensity before nVNS was 5.2 (±1.6; median 6), and 3.1 (±2.2; median 3) following stimulation; mean reduction in vertigo intensity was 46.9% (±31.5; median 45%). Five experienced headache with the VM attack; all reported improvement following nVNS. Mean headache severity was 6 (±1.4; median 6) prior to treatment and 2.4 (±1.5; median 3) following nVNS; mean reduction in headache intensity was 63.3% (±21.7; median 50). All 4 treated with nVNS for interictal PPPD reported no benefit. CONCLUSION: Our study provides preliminary evidence that nVNS may provide rapid relief of vertigo and headache in acute VM, and supports further randomized, sham-controlled studies into nVNS in VM. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with acute VM, nVNS rapidly relieves vertigo and headache.


Assuntos
Cefaleia/terapia , Transtornos de Enxaqueca/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação do Nervo Vago/métodos , Vertigem/terapia , Doença Aguda , Adulto , Idoso , Feminino , Cefaleia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Vertigem/fisiopatologia , Doenças Vestibulares/fisiopatologia , Doenças Vestibulares/terapia , Adulto Jovem
11.
Aten. prim. (Barc., Ed. impr.) ; 51(7): 406-415, ago.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185728

RESUMO

Objetivo: Determinar si la estimulación eléctrica nerviosa transcutánea (TENS) tiene un efecto analgésico superior al placebo o a otros tratamientos en pacientes con fibromialgia. Además, se pretendía analizar los parámetros de aplicación óptimos para conseguir una mayor reducción del dolor. Diseño: Revisión sistemática: Fuentes de datos: Ensayos clínicos aleatorizados sobre el efecto del TENS en la fibromialgia en las bases de datos Pubmed, Cochrane y PEDro hasta noviembre de 2016. Selección de estudios: Se seleccionaron 8 estudios de un total de 62. Se incluyeron ensayos clínicos controlados en los que se aplicase TENS a personas con fibromialgia. Extracción de datos: Se analizó el dolor como variable principal, aunque también se incluyeron otras variables como fatiga, calidad de vida e impacto de la enfermedad, recorrido articular y depresión. Resultados: Seis de 8 trabajos obtuvieron una disminución significativa del dolor. En 2 estudios se aplicó el TENS como tratamiento complementario al ejercicio terapéutico con resultados evidenciando una disminución del dolor. El resto de variables estudiadas presentaron gran variabilidad y no se pudieron establecer resultados concluyentes. Conclusiones: El tratamiento con TENS resulta efectivo para la disminución del dolor en personas con fibromialgia. Además, la inclusión del TENS en programas de ejercicio terapéutico parece tener un efecto superior a la realización del ejercicio terapéutico de forma aislada. Sin embargo, no se ha demostrado eficacia en otras variables diferentes al dolor. Son necesarios más estudios que indaguen en la optimización de los parámetros del TENS y un mayor consenso entre las variables utilizadas


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


Assuntos
Humanos , Estimulação Elétrica Nervosa Transcutânea/métodos , Fibromialgia/terapia , Analgesia , Clínicas de Dor , Manejo da Dor
12.
Fisioter. Pesqui. (Online) ; 26(3): 220-226, jul.-set. 2019. graf
Artigo em Português | LILACS | ID: biblio-1039896

RESUMO

RESUMO Lesões de nervos periféricos levam a perda funcional elevada no tecido muscular. Assim, muitas pesquisas têm investigado técnicas cirúrgicas, como neurorrafias, e recursos terapêuticos, como eletroestimulação, para melhorar a funcionalidade de um músculo reinervado após lesão periférica. Este estudo tem como objetivo investigar os efeitos da eletroestimulação com corrente russa (2.500Hz, 4ms, 10 seg. de contração por 20 seg. de relaxamento, modulação de 10Hz e 100 Hz) na recuperação funcional após secção e neurorrafia término-lateral do coto distal do nervo fibular comum à face lateral do nervo tibial em ratos. Foram utilizados 25 ratos Wistar, machos, com 80 dias de vida, fornecidos pelo Biotério Central da Universidade Sagrado Coração (Bauru, SP, Brasil). Os animais foram divididos aleatoriamente em cinco grupos: grupo-controle Inicial (GCI), grupo-controle final (GCF), grupo experimental não tratado (GENT), grupo neurorrafia término-lateral com estimulação russa (GNTLER) e grupo-controle desnervado (GCD). A corrente russa foi iniciada cinco dias após neurorrafia e aplicada no músculo tibial cranial do GNTLER, 3 vezes por semana, totalizando 36 sessões. A estimulação elétrica foi eficaz para aumentar a amplitude e diminuir a latência do músculo reinervado, além de aumentar a força muscular em comparação ao GCD. Diante disso, conclui-se que a eletroestimulação de média frequência (corrente russa) foi eficiente na recuperação funcional do músculo tibial cranial após neurorrafia término-lateral do nervo fibular comum.


RESUMEN Las lesiones de los nervios periféricos ocasionan una elevada pérdida funcional en el tejido muscular. De esta manera, en muchos estudios se han investigado técnicas quirúrgicas, como neurorrafias, y recursos terapéuticos, como la electroestimulación, para mejorar la funcionalidad del músculo reinervado tras una lesión periférica. El presente estudio tiene como objetivo investigar los efectos de la electroestimulación con corrente rusa (2.500Hz, 4ms, 10 seg. de contracción por 20 seg. de relajación, modulación de 10Hz y 100Hz) en la recuperación funcional tras la sección y neurorrafia término-lateral del muñón distal del nervio fibular común en la parte lateral del nervio tibial en ratas. Se utilizaron 25 ratas Wistar, machos, con 80 días de vida, proporcionadas por el Biotério Central de la Universidade do Sagrado Coração (Bauru, SP, Brasil). Se dividieron aleatoriamente los animales en cinco grupos: grupo de control inicial (GCI), grupo de control final (GCF), grupo experimental no tratado (GENT), grupo de neurorrafia término-lateral con estimulación rusa (GNTLER) y grupo de control denervado (GCD). La corriente rusa se inició cinco días tras la neurorrafia, siendo que la aplicó al músculo tibial craneal del GNTLER 3 veces a la semana, con un total de 36 sesiones. La estimulación eléctrica se mostró efectiva para aumentar la amplitud y disminuir la latencia del músculo reinervado, además de aumentar la fuerza muscular en comparación con el GCD. Por lo tanto, se concluye que la estimulación eléctrica de frecuencia media (corriente rusa) fue eficaz en la recuperación funcional del músculo tibial craneal tras la neurorrafia término-lateral del nervio fibular común.


ABSTRACT Peripheral nerve injury leads to a high functional loss of muscle tissue. Thus, many studies have investigated surgical techniques, such as neurorraphies, and therapeutic resources, such as electrical stimulation, to improve the functionality of reinnervated muscle after peripheral injury. This study aims to investigate the effects of electrical stimulation with Russian Current (2,500Hz, 4ms, 10:20 sec contraction/relaxation, modulated at 10Hz and 100Hz) in the functional recovery after section and end-to-side neurorrhaphy of the peroneal nerve distal stump common to the lateral face of the tibial nerve in rats. In this study, 25 male Wistar rats with 80 days of life were used, provided by the Universidade Sagrado Coração (USC), Bauru, SP, Brazil. The animals were randomly divided into five groups: Initial Control Group (ICG), Final Control Group (FCG), Untreated Experimental Group (UEG), End-to-Side Neurorrhaphy with Russian Stimulation Group (ENRSG), and Denervated Control Group (DCG). The Russian Current was started 5 days after neurorrhaphy and applied to the cranial tibial muscle of the ENRSG, 3 times a week, totaling 36 sessions. We observed that the electrical stimulation with Russian Current (ENRSG) was effective to increase amplitude (mV) and to decrease the latency (ms) of the reinnervated muscle, besides increasing the muscle strength when compared with the denervated control group. Therefore, we concluded that the average frequency electrical stimulation (Russian current) was efficient in the functional recovery of the cranial tibial muscle after the end-lateral neurorrhaphy of the common fibular nerve.


Assuntos
Animais , Masculino , Nervo Fibular/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Regeneração Nervosa , Ratos Wistar , Eletromiografia , Força Muscular , Traumatismos dos Nervos Periféricos/cirurgia
13.
Biomed Res Int ; 2019: 9073073, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380442

RESUMO

The study investigated touch and pain sensations and the correlation between them in diadynamic current (DD) and transcutaneous electrical nerve stimulation (TENS), electrotherapies commonly applied in musculoskeletal disorders and occupational rehabilitation medicine. Forty healthy subjects were treated with either DD (n=20) or TENS (n=20). Each treatment consisted of three sessions with one-week interval. Touch sensation was determined with the JVP Domes esthesiometer, pain sensation with pressure pain threshold (PPT), and pressure pain tolerance threshold (PPTO) by an algometer. During each session the measurements were performed before the application of the procedure (T0), immediately after it (T1), and 30 minutes after the end of the procedure (T2). Both DD and TENS increased touch sensation (p<0.01) and did not significantly alter PPT and PPTO (p>0.05). No statistically significant differences in short-term effects, i.e., 3 weeks of the trial, were noted between DD and TENS in their influence on touch and pain sensations (p>0.05). There was a high significant correlation between touch and pain sensations in DD (r=0.86). TENS and DD caused similar analgesic effects. DD, which is shorter in the duration of the treatment, may comprise a realistic alternative to TENS in clinical practice of pain management.


Assuntos
Terapia por Estimulação Elétrica , Manejo da Dor/métodos , Tato/fisiologia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Feminino , Humanos , Masculino , Medição da Dor/métodos , Percepção da Dor/fisiologia , Adulto Jovem
14.
Transplant Proc ; 51(7): 2501-2502, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31405733

RESUMO

OBJECTIVE: Urologic complications are among the most common complications after kidney transplantation. These complications are urinary retention, hematuria, hemorrhage, urinary leakage, vesicoureteral reflux, pyelonephritis, and nephrolithiasis. Although neurogenic bladder is one of the indications for kidney transplantation, it is not considered in the literature to be an expected complication after transplantation. In this case, we discuss the nursing care of a patient who underwent kidney transplantation from a living donor and developed neurogenic bladder. CASE REPORT: A 60-year-old woman underwent kidney transplantation from a living donor, and neurogenic bladder developed in the patient 1 year after kidney transplantation. Clear intermittent catheterization treatment was administered for the kidney transplant recipient with neurogenic bladder. Clear intermittent catheterization treatment was stopped in the patient who had frequent urinary tract infections and, alternatively, sacral neuromodulation treatment was administered to the patient. CONCLUSIONS: The nursing care of a patient with neurogenic bladder after kidney transplantation aims to prevent excessive bladder distension, infection, stone formation, vesicoureteral reflux, renal failure, urinary tract damage, and incontinence, and to ensure regular and complete discharge of the bladder. The most common treatment modalities for these objectives are permanent or intermittent catheterization, sacral neuromodulation, and medical therapy. In the care of the patient with neurogenic bladder after kidney transplantation, nurses should provide appropriate care related to treatment options and bladder training, plan urination schedules of the patient, and monitor for possible complications.


Assuntos
Transplante de Rim/efeitos adversos , Bexiga Urinaria Neurogênica/etiologia , Bexiga Urinaria Neurogênica/enfermagem , Bexiga Urinaria Neurogênica/terapia , Feminino , Humanos , Cateterismo Uretral Intermitente/efeitos adversos , Pessoa de Meia-Idade , Estimulação Elétrica Nervosa Transcutânea/métodos , Infecções Urinárias/etiologia , Infecções Urinárias/terapia
15.
Best Pract Res Clin Anaesthesiol ; 33(1): 37-46, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31272652

RESUMO

A perineural catheter with a continuous infusion of local anesthetic is an excellent option for postoperative analgesia; however, its limitations include limited duration of action (i.e., 3-7 days) as well as a risk of infection and dislodgement. Furthermore, these blocks may cause dense sensory and motor blockades that under certain circumstances may not be ideal. There is novel evidence that ultrasound-guided percutaneous peripheral nerve stimulation (pPNS) may serve as an alternative approach free of the limitations associated with peripheral nerve blocks. In this review, we discuss the evidence for pPNS on postoperative acute pain management. Subsequently, we briefly discuss additional alternatives to continuous peripheral nerve blocks, including cryoanalgesia and liposomal bupivacaine.


Assuntos
Cateteres de Demora , Dor Pós-Operatória/diagnóstico por imagem , Dor Pós-Operatória/prevenção & controle , Nervos Periféricos/diagnóstico por imagem , Estimulação Elétrica Nervosa Transcutânea/métodos , Ultrassonografia de Intervenção/métodos , Analgesia/métodos , Analgesia/tendências , Cateteres de Demora/tendências , Humanos , Nervos Periféricos/efeitos dos fármacos , Estimulação Elétrica Nervosa Transcutânea/tendências , Ultrassonografia de Intervenção/tendências
16.
J Ovarian Res ; 12(1): 65, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324205

RESUMO

BACKGROUND: Premature ovarian insufficiency (POI) is characterized by early loss of ovarian function that affects women before the age of 40. We aim to explore the protective effects of transcutaneous electrical acupoint stimulation (TEAS) against irradiation-induced ovarian damage in mice. METHODS: C57BL6 mice were randomly divided into control and irradiation (IR) groups. Then, control group was divided into two treatment subgroups: mock TEAS treatment (control-) and TEAS treatment (control+). IR group was divided into four subgroups according to the time of treatment started: mock TEAS treatment initiated at 2 days after irradiation (IR 2D-), TEAS treatment initiated at 2 days after irradiation (IR 2D+), mock TEAS treatment initiated at 1 week after irradiation (IR 1 W-), and TEAS treatment initiated at 1 week after irradiation (IR 1 W+). The radiation model mice were exposed to single whole body X-ray irradiation (4 Gy), and the control mice received 0 Gy. TEAS stimulation (2 Hz, 1 mA, 30 min/day) was given once a day for six consecutive days per week for 2 weeks. Estrous cycle, ovarian weight, serum AMH level and follicle counts were evaluated. Then, proliferation markers, apoptotic markers and oxidative stress markers were examined. RESULTS: Compared with the control group, the estrous cycle was disordered, and the ovarian weight, serum AMH, and primordial, primary and secondary follicles counts decreased (all P < 0.01) in the IR 2D- and IR 1 W- groups. In the irradiation with early TEAS treatment group (IR 2D+), the estrous cycle improved, the AMH level and primordial follicular significantly increased compared to the irradiation with mock group (IR 2D-). However, there were no significant differences in the estrous cycle, AMH level and follicle counts between IR 1 W- and IR 1 W+ groups. Moreover, IR 2D+ mice reduced the expression of Bax protein and increased the levels of Bcl-2 and PCNA compared to the IR 2D- group. Furthermore, the early TEAS treated mice showed significantly lower levels of oxidative stress and number of TUNEL (+) granulosa cells than that in the IR 2D- group. CONCLUSION: This study is first to evaluate TEAS as a potential therapy to attenuate irradiation-induced ovarian failure through inhibiting primordial follicles loss, increasing serum AMH secretion, inducing antioxidant, and anti-apoptotic systems.


Assuntos
Pontos de Acupuntura , Eletroacupuntura , Insuficiência Ovariana Primária/etiologia , Insuficiência Ovariana Primária/prevenção & controle , Radioterapia/efeitos adversos , Estimulação Elétrica Nervosa Transcutânea , Animais , Biomarcadores , Modelos Animais de Doenças , Eletroacupuntura/métodos , Feminino , Expressão Gênica , Camundongos , Folículo Ovariano/citologia , Folículo Ovariano/metabolismo , Estresse Oxidativo , Insuficiência Ovariana Primária/metabolismo , Lesões Experimentais por Radiação , Estimulação Elétrica Nervosa Transcutânea/métodos , Raios X
17.
Curr Pain Headache Rep ; 23(9): 64, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31359171

RESUMO

PURPOSE OF REVIEW: Phantom sensations are incompletely understood phenomena which take place following an amputation or deafferentation of a limb. They can present as kinetic, kinesthetic, or exteroceptive perceptions. It is estimated that phantom limb pain (PLP) affects anywhere from 40 to 80% of amputees. RECENT FINDINGS: Psychiatric illnesses such as depression, anxiety, and mood disorders have higher prevalence in amputees than in the general population. Pharmacologic treatment has been used as first-line therapy for amputees suffering from PLP with agents including gabapentinoids, amitriptyline, and other tricyclic anti-depressants, opioids, and local anesthetics. Non-invasive treatment modalities exist for PLP including sensory motor training, mirror visual therapy, and non-invasive neuromodulation. Non-invasive neuromodulation includes interventions like transcutaneous electrical nerve stimulation (TENS) and transcranial magnetic stimulation. While many promising therapies for PLP exist, more clinical trials are required to determine the efficacy and protocols needed for maximum benefit in patients suffering from PLP.


Assuntos
Manejo da Dor/métodos , Medição da Dor/métodos , Membro Fantasma/diagnóstico , Membro Fantasma/terapia , Analgésicos/administração & dosagem , Humanos , Estimulação Elétrica Nervosa Transcutânea/métodos , Resultado do Tratamento
18.
Neuromodulation ; 22(6): 751-757, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31347247

RESUMO

AIMS: To investigate the effects and possible mechanisms of transcutaneous electrical acustimulation (TEA) combined with deep breathing training (DBT) on refractory gastroesophageal reflux disease (rGERD). METHODS: Twenty-one patients with rGERD were recruited and randomly assigned to receive either only esomeprazole (ESO, 20 mg bid) (group A, n = 7), TEA + DBT + ESO (group B, n = 7), or sham-TEA + DBT + ESO (group C, n = 7) in a four-week study. The reflux diagnostic questionnaire (RDQ) score and heart rate variability (HRV) were recorded and evaluated at baseline and at the end of each treatment. Blood samples were collected for the measurement of serum acetylcholine (Ach) and nitric oxide (NO). Esophageal manometry and 24-hour pH monitoring were performed before and after the treatment. RESULTS: After treatment, 1) the participants in group B had significantly lower scores of RDQ and DeMeester and increased lower esophageal sphincter pressure (LESP) than those in group C (all p < 0.05), suggesting the role of TEA; 2) low frequency band (LF)/(LF + HF) ratio in groups B and C was decreased, compared with group A (p = 0.010, p = 0.042, respectively); high frequency band (HF)/(LF + HF) ratio in B and C groups was significantly increased, compared with group A (p = 0.010, p = 0.042, respectively); 3) The serum Ach in groups B and C was significantly higher than group A (p = 0.022, p = 0.046, respectively); the serum NO in groups B and C was significantly lower than group A (p = 0.010, p = 0.027, respectively). CONCLUSIONS: TEA combined with the DBT can effectively improve the reflux symptoms in rGERD patients by increasing LESP and reducing gastroesophageal reflux, which may be mediated via the autonomic and enteric mechanisms.


Assuntos
Vias Autônomas/fisiologia , Exercícios Respiratórios/métodos , Refluxo Gastroesofágico/fisiopatologia , Refluxo Gastroesofágico/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Terapia Combinada/métodos , Esfíncter Esofágico Inferior/inervação , Esfíncter Esofágico Inferior/fisiologia , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Masculino , Manometria/métodos , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
19.
Pain Res Manag ; 2019: 7964897, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31316682

RESUMO

Objective: Studies regarding the combination of ultrasound and transcutaneous electrical nerve stimulation (TENS) are rarely reported. In this study, we aimed to elucidate the efficacy and safety of a stimulator using low-intensity pulsed ultrasound (LIPUS) combined with TENS in patients with painful knee osteoarthritis (OA). We evaluated the effectiveness of this therapy against pain, physical function, and cartilage regeneration. Moreover, we aim to prove the superiority of the effects of LIPUS combined with TENS therapy compared with only TENS therapy. Methods: Of the 40 included patients, aged 45-85 years with painful knee OA, 20 patients received only TENS therapy and 20 patients received LIPUS combined with TENS therapy for 8 weeks (a total of more than 80 treatment sessions). We evaluated visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, MOS 36-Item Short-Form Health Survey (SF-36), and femoral articular cartilage (FAC) thickness. The evaluation was performed at three visits: visit 1 (V1, pretreatment, within 28 days after screening), visit 2 (V2, posttreatment period 1, ±3 days after treatment), and visit 3 (V3, posttreatment period 2, 21 ± 3 days after treatment). Results: We expected that LIPUS combined with TENS therapy would be superior to only TENS therapy. However, there was no significant difference between the two therapies. In the within-group comparison, both treatments (only TENS therapy and LIPUS with TENS therapy) demonstrated statistical differences from baseline values for pain and physical function outcomes. FAC thickness showed no significant differences after treatment in both groups. Conclusion: The effects of a stimulator using LIPUS with TENS on pain relief and functional improvement were not superior to the only TENS therapy. Cartilage regeneration, which was expected as an additional benefit of LIPUS, was also not significantly evident. Therefore, further investigation is warranted to determine whether the combination therapy is beneficial. This trial is registered with KCT0003883.


Assuntos
Terapia Combinada/métodos , Osteoartrite do Joelho/terapia , Manejo da Dor/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Terapia por Ultrassom/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Método Simples-Cego , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos , Resultado do Tratamento , Terapia por Ultrassom/efeitos adversos , Ondas Ultrassônicas/efeitos adversos
20.
Handb Clin Neurol ; 160: 23-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277851

RESUMO

Waveform analysis plays an important role in the assessment of nerve and muscle action potentials. A sequence of potential changes arises as two sufficiently close wave fronts, leading and trailing dipoles, travel in the volume conductor from left to right. This results in a positive-negative-positive triphasic wave as depolarization and repolarization approach, reach, and finally pass beyond the point of the recording electrode. Physiologic temporal dispersion can reduce the area of a short-duration sensory potential by phase cancellation. Pathologic temporal dispersion, which can reduce the size of muscle action potential, may conversely increase the size of a sensory response by countering the physiologic phase cancellation. The near-field potential relates to the propagating signal recorded when the impulse passes under the pickup electrodes, whereas the far-field potential implies either a distant nonpropagating signal or a stationary peak generated by a propagating signal when it crosses a volume conductor junction located far from the recording site. The second type of far-field signal, or junctional potential, helps detect a voltage source generated at a distance before the signal reaches the pickup electrodes. A consensus has emerged that the volume entered becomes initially positive compared with the volume departed when the generator approaches the boundary of a volume conductor followed by a negative rebound.


Assuntos
Potenciais de Ação/fisiologia , Músculo Esquelético/fisiologia , Condução Nervosa/fisiologia , Animais , Humanos , Estimulação Elétrica Nervosa Transcutânea/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA