Transcutaneous electrical nerve stimulation

Last updated
Transcutaneous electrical nerve stimulation
Tens.jpg
A four-lead TENS unit with two channels (two lead wires per channel)
MeSH D004561

A transcutaneous electrical nerve stimulation (TENS or TNS) is a device that produces mild electric current to stimulate the nerves for therapeutic purposes. TENS, by definition, covers the complete range of transcutaneously applied currents used for nerve excitation, but the term is often used with a more restrictive intent, namely, to describe the kind of pulses produced by portable stimulators used to reduce pain.[ citation needed ] The unit is usually connected to the skin using two or more electrodes which are typically conductive gel pads. A typical battery-operated TENS unit is able to modulate pulse width, frequency, and intensity. Generally, TENS is applied at high frequency (>50  Hz) with an intensity below motor contraction (sensory intensity) or low frequency (<10 Hz) with an intensity that produces motor contraction. More recently, many TENS units use a mixed frequency mode which alleviates tolerance to repeated use. Intensity of stimulation should be strong but comfortable with greater intensities, regardless of frequency, producing the greatest analgesia. [1] While the use of TENS has proved effective in clinical studies, there is controversy over which conditions the device should be used to treat. [2]

Contents

Medical uses

Pain

Transcutaneous electrical nerve stimulation is a commonly used treatment approach to alleviate acute and chronic pain by reducing the sensitization of dorsal horn neurons, elevating levels of gamma-aminobutyric acid and glycine, and inhibiting glial activation. [3] Many systematic reviews and meta-analyses assessing clinical trials looking at the efficacy of TENS for different sources of pain, however, have been inconclusive due to a lack of high-quality and unbiased evidence. [4] [5] Potential benefits of TENS treatment include its safety profile, relative affordability, ease of self-administration, and availability over-the-counter without a prescription. [4] In principle, an adequate intensity of stimulation is necessary to achieve pain relief with TENS. [6] [7] An analysis of treatment fidelity—meaning that the delivery of TENS in a trial was in accordance with current clinical advice, such as using "a strong but comfortable sensation" and suitable, frequent treatment durations—showed that higher-fidelity trials tended to have a positive outcome. [8]

Acute pain

For people with recent-onset pain i.e., fewer than three months, such as pain associated with surgery, trauma, and medical procedures, TENS may be better than placebo in some cases. The evidence of benefit is very weak, though. [4]

Musculoskeletal and neck/back pain

There is some evidence to support a benefit of using TENS in chronic musculoskeletal pain. [9] Results from a task force on neck pain in 2008 found no clinically significant benefit of TENS for the treatment of neck pain when compared to placebo. A 2010 review did not find evidence to support the use of TENS for chronic low back pain. [10] [11]

Another study examining knee osteoarthritis patients found that TENS demonstrated efficacy and a better safety profile relative to weak opiates. Given the age, comorbidity frequency, tendency toward polypharmacy, and sensitivity to adverse reactions among individuals most frequently reporting osteoarthritis, TENS could be a non-pharmacological alternative to analgesics in the management of knee osteoarthritis pain. [12]

Neuropathy and phantom limb pain

There is tentative evidence that TENS may be useful for painful diabetic neuropathy. [10] As of 2015, the efficacy of TENS for phantom limb pain is unknown; no randomized controlled trials have been performed. [13]

A few studies have shown objective evidence that TENS may modulate or suppress pain signals in the brain. One used evoked cortical potentials to show that electric stimulation of peripheral A-beta sensory fibers reliably suppressed A-delta fiber nociceptive (pain perception) processing. [14] Two other studies used functional magnetic resonance imaging (fMRI): one showed that high-frequency TENS produced a decrease in pain-related cortical activations in patients with carpal tunnel syndrome, [15] while the other showed that low-frequency TENS decreased shoulder impingement pain and modulated pain-induced activation in the brain. [16]

Labor and menstrual pain

Early studies found that TENS "has been shown not to be effective in postoperative and labour pain." These studies also had questionable ability to truly blind the patients. [17] [18] However, more recent studies have shown that TENS was "effective for relieving labour pain, and they are well considered by pregnant participants." [19] One study also showed that there was a significant change in laboring individuals' time to request analgesia such as an epidural. The group with the TENS waited five additional hours relative to those without TENS. Both groups were satisfied with the pain relief that they had from their choices. No maternal, infant, or labor problems were noted. [20] There is tentative evidence that TENS may be helpful for treating pain from dysmenorrhoea, however further research is required. [21] [22]

Cancer pain

Non-pharmacological treatment options for people experiencing pain caused by cancer are much needed, however, it is not clear from the weak studies that have been published if TENS is an effective approach. [23] [24]

Bladder function

Percutaneous and transcutaneous electrical nerve stimulation in the tibial nerve have been used in the treatment of overactive bladder and urinary retention. [25] [26] Sometimes it is also done in the sacrum. [27] Systematic review studies have shown limited evidence on the effectiveness, and more quality research is needed. [27] [28] [29] A major trial found that in a care home context transcutaneous posterior tibial nerve stimulation did not improve urinary incontinence. [30]

Dentistry

TENS has been extensively used in non-odontogenic orofacial pain relief. [31] In addition, TENS and ultra low frequency-TENS (ULF-TENS) are commonly employed in diagnosis and treatment of temporomandibular joint dysfunction (TMD). [31] Further clinical studies are required to determine its efficacy. [31]

Tremor

A wearable neuromodulation device that delivers electrical stimulation to nerves in the wrist is now available by prescription. Worn around the wrist, it acts as a non-invasive treatment for those living with essential tremor. [32] The stimulator has electrodes that are placed circumferentially around a patient's wrist. Positioning the electrodes on generally opposing sides of the target nerve can result in improved stimulation of the nerve. [33] In clinical trials reductions in hand tremors were reported following noninvasive median and radial nerve stimulation. [34]

Transcutaneous afferent patterned stimulation (TAPS) is a tremor-customized therapy, based on the patient's measured tremor frequency, and is delivered transcutaneously to the median and radial nerves of a patient's wrist. The patient specific TAPS stimulation is determined through a calibration process performed by the accelerometer and microprocessor on the device. [35]

The Cala ONE delivers TAPS in a wrist-worn device that is calibrated to treat tremor symptoms. Cala ONE received de novo FDA clearance in April 2018 for the transient relief of hand tremors in adults with essential tremor and is currently marketed as Cala Trio. [35]

Contraindications

People who have implanted electronic medical devices including pacemakers and cardiodefibrillators are not suggested to use TENS. [4] In addition, caution should be taken before using TENS in those who are pregnant, have epilepsy, have an active malignancy, have deep vein thrombosis, have skin that is damaged, or are frail. [4] The use of TENS is likely to be less effective on areas of numb skin or decreased sensation due to nerve damage. It may also cause skin irritation due to the inability to feel currents until they are too high. [36] There is an unknown level of risk when placing electrodes over an infection (possible spreading due to muscle contractions), but cross contamination with the electrodes themselves is of greater concern. [37]

There are several anatomical locations where TENS electrodes are contraindicated:

Cardiac pacemakers

TENS used across an artificial cardiac pacemaker or other indwelling stimulator, including across its leads, may cause interference and failure of the implanted device. Serious accidents have been recorded in cases when this principle was not observed. A 2009 review in this area suggests that electrotherapy, including TENS, is "best avoided" in patients with pacemakers or implantable cardioverter-defibrillators (ICDs). They add that "there is no consensus and it may be possible to safely deliver these modalities in a proper setting with device and patient monitoring", and recommend further research. The review found several reports of ICDs administering inappropriate treatment due to interference with TENS devices, but notes that the reports on pacemakers are mixed: some non-programmable pacemakers were inhibited by TENS, but others were unaffected or auto-reprogrammed. [40]

Pregnancy

TENS should be used with caution on people with epilepsy or on pregnant women; do not use over area of the uterus, as the effects of electrical stimulation on the developing fetus are not known. [39] [41]

Side effects

Overall, TENS has been found to be safe compared with pharmaceutical medications for treating pain. [4] Potential side effects include skin itching near the electrodes and mild redness of the skin (erythema). [4] Some people also report that they dislike the sensation associated with TENS. [4]

Device types

The TENS device acts to stimulate the sensory nerves and a small portion of the peripheral motor nerves; the stimulation causes multiple mechanisms to trigger and manage the sense of pain in a patient. TENS operates by two main mechanisms: it stimulates competing sensory neurons at the pain perception gate, and it stimulates the opiate response. [42] The mechanism that will be used varies with the type of device.[ citation needed ]

The table below lists the types of devices:

ParametersPatient's feelingsLocations of the electrodesPurpose of therapyTherapy instructionsHow to relieve pain
Conventional TENSLow amplitude and high frequency (90–130 Hz) [43] A strong but painless sensation of impact and minimal muscular activityOn the skin, in the pain spotStimulate big-diameter nerve fibers, Aβ, for local pain relief.Use as neededPain relief is normally quick both in and after the therapy sessions
AL-TENSHigh amplitude and low frequency (1–5 Hz transmissions)A strong but painless sensation of strained musclesTop of the muscle in a sore muscle area to activate the motor nerves.Stimulate the narrow-diameter skin nerve fibers as well as the Aδ motor fibers for pain relief in the segmental space around the area of pain.For a limited use of 20 to 30 minutes at a time [44] A response delay may occur
Intense TENSHigh amplitudePainful sensation of electrical impact in this areaOn the skin area proximal to the spot of pain [45] Stimulate narrow-diameter Aδ skin nerve fibers and create a counterstimulus (it will ease the existing stimulus)For a short-term use of 5 to 15 minutes at a timeA fast response within the therapy range and a delayed response after it

History

Electrical stimulation for pain control was used in ancient Rome, in AD 63. It was reported by Scribonius Largus that pain was relieved by standing on an electrical fish at the seashore. [46] In the 16th through the 18th centuries various electrostatic devices were used for headache and other pains. Benjamin Franklin was a proponent of this method for pain relief. [47] In the 19th century a device called the electreat, along with numerous other devices were used for pain control and cancer cures. Only the electreat survived into the 20th century, but was not portable, and had limited control of the stimulus.[ citation needed ] Development of the modern TENS unit is generally credited to C. Norman Shealy. [48]

Modern

The first modern, patient-wearable TENS was patented in the United States in 1974. [49] It was initially used for testing the tolerance of chronic pain patients to electrical stimulation before implantation of electrodes in the spinal cord dorsal column. [50] The electrodes were attached to an implanted receiver, which received its power from an antenna worn on the surface of the skin. Although intended only for testing tolerance to electrical stimulation, many of the patients said they received so much relief from the TENS itself that they never returned for the implant.[ citation needed ]

A number of companies began manufacturing TENS units after the commercial success of the Medtronic device became known. The neurological division of Medtronic, founded by Don Maurer, Ed Schuck and Charles Ray, developed a number of applications for implanted electrical stimulation devices for treatment of epilepsy, Parkinson's disease, and other disorders of the nervous system.[ citation needed ]

Today many people confuse TENS with electrical muscle stimulation (EMS). EMS and TENS devices look similar, with both using long electric lead wires and electrodes. TENS is for blocking pain, where EMS is for stimulating muscles.[ citation needed ]

Beginning in the late 1970s, in the USSR as part of their space program further research was conducted into electronic pain reduction devices. Dr. Alexander Karasev developed scenar (or skenar) devices, and later in the early 2000s cosmodic devices. Each of these device types uses the fundamental technique of reading electrical signals in the skin, analyzing the signals, and returning therapeutic electrical pulses into the nerves. He terms the TENS devices first generation electronic pain relief devices, scenar devices second generation devices, cosmodic devices as third generation devices, and the D.O.V.E. (Device Organizing Vital Energy) device as an advanced second generation device which automatically incorporates some cosmodic therapeutic features. [51]

Research

As reported, TENS has different effects on the brain. [14] A randomized controlled trial in 2017 shown that sensory ULF-TENS applied on the skin proximally to trigeminal nerve, reduced the effect of acute mental stress assessed by heart rate variability (HRV). [52] Further high quality studies are required to determine the effectiveness of TENS for treating dementia. [53] [54]

A head-mounted TENS device called Cefaly was approved by the United States Food and Drug Administration (FDA), in March 2014, for the prevention of migraine attacks. The Cefaly device was found effective in preventing migraine attacks in a randomized sham-controlled trial. [55] This was the first TENS device the FDA approved for pain prevention, as opposed to pain suppression. [56]

A study performed on healthy human subjects demonstrates that repeated application of TENS can generate analgesic tolerance within five days, reducing its efficacy. [57] The study noted that TENS causes the release of endogenous opioids, and that the analgesia is likely due to opioid tolerance mechanisms. [57]

The pain reduction ability of TENS is unconfirmed by sufficient randomized controlled trials so far. One meta-analysis of several hundred TENS studies concluded that there was a significant overall reduction of pain intensity due to TENS, but there were too few participants and controls to be entirely certain of their validity. Therefore, the authors downgraded their confidence in the results by two levels, to low-certainty. [58]

See also

Related Research Articles

<span class="mw-page-title-main">Fibromyalgia</span> Chronic pain of unknown cause

Fibromyalgia is a medical syndrome that causes chronic widespread pain, accompanied by fatigue, awakening unrefreshed, and cognitive symptoms. Other symptoms can include headaches, lower abdominal pain or cramps, and depression. People with fibromyalgia can also experience insomnia and general hypersensitivity. The cause of fibromyalgia is unknown, but is believed to involve a combination of genetic and environmental factors. Environmental factors may include psychological stress, trauma, and some infections. Since the pain appears to result from processes in the central nervous system, the condition is referred to as a "central sensitization syndrome".

<span class="mw-page-title-main">Pain management</span> Interdisciplinary approach for easing pain

Pain management is an aspect of medicine and health care involving relief of pain in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals provide some pain control in the normal course of their practice, and for the more complex instances of pain, they also call on additional help from a specific medical specialty devoted to pain, which is called pain medicine.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerve fibers are affected. Neuropathies affecting motor, sensory, or autonomic nerve fibers result in different symptoms. More than one type of fiber may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Low back pain</span> Medical condition

Low back pain or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute, sub-chronic, or chronic. The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.

Electroacupuncture is a form of acupuncture where a small electric current is passed between pairs of acupuncture needles.

Postherpetic neuralgia (PHN) is neuropathic pain that occurs due to damage to a peripheral nerve caused by the reactivation of the varicella zoster virus. PHN is defined as pain in a dermatomal distribution that lasts for at least 90 days after an outbreak of herpes zoster. Several types of pain may occur with PHN including continuous burning pain, episodes of severe shooting or electric-like pain, and a heightened sensitivity to gentle touch which would not otherwise cause pain or to painful stimuli. Abnormal sensations and itching may also occur.

Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. Neuropathic pain may be associated with abnormal sensations called dysesthesia or pain from normally non-painful stimuli (allodynia). It may have continuous and/or episodic (paroxysmal) components. The latter resemble stabbings or electric shocks. Common qualities include burning or coldness, "pins and needles" sensations, numbness and itching.

<span class="mw-page-title-main">Electrotherapy</span> Use of electricity for medical purposes, and to stimulate Muscle for more strength.

Electrotherapy is the use of electrical energy as a medical treatment. In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of electric current to speed wound healing. The use of EMS is also very wide for managing muscular pain. Additionally, the term "electrotherapy" or "electromagnetic therapy" has also been applied to a range of alternative medical devices and treatments. Evidence supporting the effectiveness of electrotherapy is limited.

<span class="mw-page-title-main">Vagus nerve stimulation</span> Medical treatment that involves delivering electrical impulses to the vagus nerve

Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy, cluster headaches, treatment-resistant depression and stroke rehabilitation.

Percutaneous tibial nerve stimulation (PTNS), also referred to as posterior tibial nerve stimulation, is the least invasive form of neuromodulation used to treat overactive bladder (OAB) and the associated symptoms of urinary urgency, urinary frequency and urge incontinence. These urinary symptoms may also occur with interstitial cystitis and following a radical prostatectomy. Outside the United States, PTNS is also used to treat fecal incontinence.

Electrical muscle stimulation (EMS), also known as neuromuscular electrical stimulation (NMES) or electromyostimulation, is the elicitation of muscle contraction using electric impulses. EMS has received an increasing amount of attention in the last few years for many reasons: it can be utilized as a strength training tool for healthy subjects and athletes; it could be used as a rehabilitation and preventive tool for people who are partially or totally immobilized; it could be utilized as a testing tool for evaluating the neural and/or muscular function in vivo. EMS has been proven to be more beneficial before exercise and activity due to early muscle activation. Recent studies have found that electrostimulation has been proven to be ineffective during post exercise recovery and can even lead to an increase in Delayed onset muscle soreness (DOMS).

<span class="mw-page-title-main">Transcranial direct-current stimulation</span> Technique of brain electric stimulation therapy

Transcranial direct current stimulation (tDCS) is a form of neuromodulation that uses constant, low direct current delivered via electrodes on the head. It was originally developed to help patients with brain injuries or neuropsychiatric conditions such as major depressive disorder. It can be contrasted with cranial electrotherapy stimulation, which generally uses alternating current the same way, as well as transcranial magnetic stimulation.

<span class="mw-page-title-main">Neck pain</span> Medical condition

Neck pain, also known as cervicalgia, is a common problem, with two-thirds of the population having neck pain at some point in their lives.

Sacral nerve stimulation, also termed sacral neuromodulation, is a type of medical electrical stimulation therapy.

<span class="mw-page-title-main">Responsive neurostimulation device</span> Category of medical devices that respond to signals in a patients body to treat disease

Responsive neurostimulation device is a medical device that senses changes in a person's body and uses neurostimulation to respond in the treatment of disease. The FDA has approved devices for use in the United States in the treatment of epileptic seizures and chronic pain conditions. Devices are being studied for use in the treatment of essential tremor, Parkinson's disease, Tourette's syndrome, depression, obesity, and post-traumatic stress disorder.

Electroanalgesia is a form of analgesia, or pain relief, that uses electricity to ease pain. Electrical devices can be internal or external, at the site of pain (local) or delocalized throughout the whole body. It works by interfering with the electric currents of pain signals, inhibiting them from reaching the brain and inducing a response; different from traditional analgesics, such as opiates which mimic natural endorphins and NSAIDs that help relieve inflammation and stop pain at the source. Electroanalgesia has a lower addictive potential and poses less health threats to the general public, but can cause serious health problems, even death, in people with other electrical devices such as pacemakers or internal hearing aids, or with heart problems.

Preventive treatment of migraine can be an important component of migraine management. The goals of preventive therapy are to reduce the frequency, painfulness, and/or duration of migraine attacks, and to increase the effectiveness of abortive therapy. Another reason to pursue prevention is to avoid medication overuse headache (MOH), otherwise known as rebound headache, which can arise from overuse of pain medications, and can result in chronic daily headache. Preventive treatments of migraine include medications, nutritional supplements, lifestyle alterations, and surgery. Prevention is recommended in those who have headaches more than two days a week, cannot tolerate the medications used to treat acute attacks, or those with severe attacks that are not easily controlled.

Neuromodulation is "the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body". It is carried out to normalize – or modulate – nervous tissue function. Neuromodulation is an evolving therapy that can involve a range of electromagnetic stimuli such as a magnetic field (rTMS), an electric current, or a drug instilled directly in the subdural space. Emerging applications involve targeted introduction of genes or gene regulators and light (optogenetics), and by 2014, these had been at minimum demonstrated in mammalian models, or first-in-human data had been acquired. The most clinical experience has been with electrical stimulation.

Scrambler therapy involves the use of electronic stimulation on the skin with the goal of overwhelming pain information with non-pain information. In a therapy session, "electrocardiographic-like pads are placed around the area of pain".

Trigeminal nerve stimulation (TNS) or external Trigeminal nerve stimulation (eTNS) is a non-invasive, non-medication therapy for Attention deficit hyperactivity disorder approved in the United States by the FDA for the treatment of ADHD in children ages 7–12. It is also used off-label to treat ADHD in adults.

References

  1. ↑ Robinson AJ, Snyder-Mackler L (2007). Clinical Electrophysiology: Electrotherapy and Electrophysiologic Testing (Third ed.). Lippincott Williams & Wilkins. ISBN   978-0781744843.
  2. ↑ DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA (December 2008). "Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain". Current Rheumatology Reports. 10 (6): 492–499. doi:10.1007/s11926-008-0080-z. PMC   2746624 . PMID   19007541.
  3. ↑ Huang J, Yang C, Zhao K, Zhao Z, Chen Y, Wang T, Qu Y. "Transcutaneous Electrical Nerve Stimulation in Rodent Models of Neuropathic Pain: A Meta-Analysis". Front. Neurosci. 2022 Jan 31;16:831413. doi : 10.3389/fnins.2022.831413. PMID   35173577; PMC   PMC8841820.
  4. 1 2 3 4 5 6 7 8 Johnson MI, Paley CA, Howe TE, Sluka KA (June 2015). "Transcutaneous electrical nerve stimulation for acute pain". The Cochrane Database of Systematic Reviews. 2021 (6): CD006142. doi:10.1002/14651858.CD006142.pub3. PMC   8094447 . PMID   26075732.
  5. ↑ Gibson W, Wand BM, Meads C, Catley MJ, O'Connell NE (April 2019). "Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews". The Cochrane Database of Systematic Reviews. 4 (4): CD011890. doi:10.1002/14651858.CD011890.pub3. PMC   6446021 . PMID   30941745.
  6. ↑ Bjordal JM, Johnson MI, Ljunggreen AE (2003). "Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain". European Journal of Pain. 7 (2): 181–188. doi:10.1016/S1090-3801(02)00098-8. PMID   12600800. S2CID   24737458.
  7. ↑ Rakel B, Frantz R (October 2003). "Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement". The Journal of Pain. 4 (8): 455–464. doi:10.1067/S1526-5900(03)00780-6. PMID   14622666.
  8. ↑ Bennett MI, Hughes N, Johnson MI (June 2011). "Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: low fidelity may explain negative findings". Pain. 152 (6): 1226–1232. doi:10.1016/j.pain.2010.12.009. PMID   21435786. S2CID   25712472.
  9. ↑ Johnson M, Martinson M (July 2007). "Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials". Pain. 130 (1–2): 157–165. doi:10.1016/j.pain.2007.02.007. PMID   17383095. S2CID   26643050.
  10. 1 2 Dubinsky RM, Miyasaki J (January 2010). "Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology". Neurology. 74 (2): 173–176. doi: 10.1212/WNL.0b013e3181c918fc . PMID   20042705.
  11. ↑ Khadilkar A, Odebiyi DO, Brosseau L, Wells GA (October 2008). Brosseau L (ed.). "Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain". The Cochrane Database of Systematic Reviews. 2008 (4): CD003008. doi:10.1002/14651858.CD003008.pub3. PMC   7138213 . PMID   18843638.
  12. ↑ Maheu E, Soriot-Thomas S, Noel E, Ganry H, Lespessailles E, Cortet B (2022). "Wearable transcutaneous electrical nerve stimulation (actiTENS®) is effective and safe for the treatment of knee osteoarthritis pain: a randomized controlled trial versus weak opioids". Therapeutic Advances in Musculoskeletal Disease. 14: 1759720X211066233. doi:10.1177/1759720X211066233. PMC   8777341 . PMID   35069809.
  13. ↑ Johnson MI, Mulvey MR, Bagnall AM (August 2015). "Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults". The Cochrane Database of Systematic Reviews. 8 (4): CD007264. doi:10.1002/14651858.CD007264.pub3. PMC   7209768 . PMID   26284511.
  14. 1 2 Ellrich J, Lamp S (October 2005). "Peripheral nerve stimulation inhibits nociceptive processing: an electrophysiological study in healthy volunteers". Neuromodulation. 8 (4): 225–232. doi:10.1111/j.1525-1403.2005.00029.x. PMID   22151549. S2CID   22850373.
  15. ↑ Kara M, Ozçakar L, Gökçay D, Ozçelik E, Yörübulut M, Güneri S, et al. (August 2010). "Quantification of the effects of transcutaneous electrical nerve stimulation with functional magnetic resonance imaging: a double-blind randomized placebo-controlled study". Archives of Physical Medicine and Rehabilitation. 91 (8): 1160–1165. doi:10.1016/j.apmr.2010.04.023. PMID   20684895.
  16. ↑ Kocyigit F, Akalin E, Gezer NS, Orbay O, Kocyigit A, Ada E (September 2012). "Functional magnetic resonance imaging of the effects of low-frequency transcutaneous electrical nerve stimulation on central pain modulation: a double-blind, placebo-controlled trial". The Clinical Journal of Pain. 28 (7): 581–588. doi:10.1097/AJP.0b013e31823c2bd7. PMID   22699130. S2CID   22274615.
  17. ↑ McQuay HJ, Moore RA, Eccleston C, Morley S, Williams AC (July 1997). "Systematic review of outpatient services for chronic pain control". Health Technology Assessment. 1 (6): i–iv, 1–135. doi: 10.3310/hta1060 . PMID   9483161.
  18. ↑ van der Spank JT, Cambier DC, De Paepe HM, Danneels LA, Witvrouw EE, Beerens L (November 2000). "Pain relief in labour by transcutaneous electrical nerve stimulation (TENS)". Archives of Gynecology and Obstetrics. 264 (3): 131–136. doi:10.1007/s004040000099. PMID   11129512. S2CID   1076157.
  19. ↑ Báez-Suárez A, Martín-Castillo E, García-Andújar J, García-Hernández JÁ, Quintana-Montesdeoca MP, Loro-Ferrer JF (November 2018). "Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial". Trials. 19 (1): 652. doi: 10.1186/s13063-018-3036-2 . PMC   6258317 . PMID   30477529.
  20. ↑ Santana LS, Gallo RB, Ferreira CH, Duarte G, Quintana SM, Marcolin AC (January 2016). "Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial". Journal of Physiotherapy. 62 (1): 29–34. doi: 10.1016/j.jphys.2015.11.002 . PMID   26701166.
  21. ↑ Igwea SE, Tabansi-Ochuogu CS, Abaraogu UO (August 2016). "TENS and heat therapy for pain relief and quality of life improvement in individuals with primary dysmenorrhea: A systematic review". Complementary Therapies in Clinical Practice. 24: 86–91. doi:10.1016/j.ctcp.2016.05.001. PMID   27502806.
  22. ↑ Arik MI, Kiloatar H, Aslan B, Icelli M (2020-08-29). "The effect of TENS for pain relief in women with primary dysmenorrhea: A systematic review and meta-analysis". Explore. 18 (1): 108–113. doi:10.1016/j.explore.2020.08.005. PMID   32917532. S2CID   221637541.
  23. ↑ Hurlow A, Bennett MI, Robb KA, Johnson MI, Simpson KH, Oxberry SG (March 2012). "Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults". The Cochrane Database of Systematic Reviews. 2012 (3): CD006276. doi:10.1002/14651858.CD006276.pub3. PMC   6669272 . PMID   22419313.
  24. ↑ Eccleston C, Fisher E, Thomas KH, Hearn L, Derry S, Stannard C, et al. (November 2017). "Interventions for the reduction of prescribed opioid use in chronic non-cancer pain". The Cochrane Database of Systematic Reviews. 11 (5): CD010323. doi:10.1002/14651858.CD010323.pub3. PMC   6486018 . PMID   29130474.
  25. ↑ Agost-González A, Escobio-Prieto I, Pareja-Leal AM, Casuso-Holgado MJ, Blanco-Diaz M, Albornoz-Cabello M (July 2021). "Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review". Healthcare. 9 (7): 879. doi: 10.3390/healthcare9070879 . PMC   8306496 . PMID   34356261.
  26. ↑ Coolen RL, Groen J, Scheepe JR, Blok BF (September 2021). "Transcutaneous Electrical Nerve Stimulation and Percutaneous Tibial Nerve Stimulation to Treat Idiopathic Nonobstructive Urinary Retention: A Systematic Review". European Urology Focus. 7 (5): 1184–1194. doi: 10.1016/j.euf.2020.09.019 . PMID   33268327. S2CID   226342032.
  27. 1 2 Booth J, Connelly L, Dickson S, Duncan F, Lawrence M (February 2018). "The effectiveness of transcutaneous tibial nerve stimulation (TTNS) for adults with overactive bladder syndrome: A systematic review" (PDF). Neurourology and Urodynamics. 37 (2): 528–541. doi:10.1002/nau.23351. PMID   28731583. S2CID   206304402.
  28. ↑ Ghavidel-Sardsahra A, Ghojazadeh M, Rahnama'I MS, Naseri A, Yazdandoost S, Khezerloo T, et al. (February 2022). "Efficacy of percutaneous and transcutaneous posterior tibial nerve stimulation on idiopathic overactive bladder and interstitial cystitis/painful bladder syndrome: A systematic review and meta-analysis". Neurourology and Urodynamics. 41 (2): 539–551. doi:10.1002/nau.24864. PMID   35032328. S2CID   247170572.
  29. ↑ Yang DY, Zhao LN, Qiu MX (May 2021). "Treatment for overactive bladder: A meta-analysis of transcutaneous tibial nerve stimulation versus percutaneous tibial nerve stimulation". Medicine. 100 (20): e25941. doi:10.1097/MD.0000000000025941. PMC   8137095 . PMID   34011072.
  30. ↑ Booth J, Aucott L, Cotton S, Davis B, Fenocchi L, Goodman C, et al. (June 2021). "Tibial nerve stimulation compared with sham to reduce incontinence in care home residents: Electric RCT". Health Technology Assessment. 25 (41): 1–110. doi:10.3310/hta25410. PMC   8273680 . PMID   34167637.
  31. 1 2 3 Chipaila N, Sgolastra F, Spadaro A, Pietropaoli D, Masci C, Cattaneo R, Monaco A (April 2014). "The effects of ULF-TENS stimulation on gnathology: the state of the art". Cranio. 32 (2): 118–130. doi:10.1179/0886963413Z.00000000018. PMID   24839723. S2CID   22320755.
  32. ↑ "De Novo Classification Request for Cala One" (PDF). U.S. Food and Drug Administration.
  33. ↑ Pahwa R, Dhall R, Ostrem J, Gwinn R, Lyons K, Ro S, et al. (July 2019). "An Acute Randomized Controlled Trial of Noninvasive Peripheral Nerve Stimulation in Essential Tremor". Neuromodulation. 22 (5): 537–545. doi:10.1111/ner.12930. PMC   6766922 . PMID   30701655.
  34. ↑ Lin PT, Ross EK, Chidester P, Rosenbluth KH, Hamner SR, Wong SH, et al. (July 2018). "Noninvasive neuromodulation in essential tremor demonstrates relief in a sham-controlled pilot trial". Movement Disorders. 33 (7): 1182–1183. doi: 10.1002/mds.27350 . PMC   6174932 . PMID   29663525.
  35. 1 2 "De Novo Classification Request for Cala One" (PDF). FDA.
  36. 1 2 3 4 5 6 7 Watson, p. 266
  37. ↑ Robertson, p. 160
  38. ↑ Bracciano AG (2008). Physical Agent Modalities: Theory and Application for the Occupational Therapist (2 ed.). Slack Incorporated. p. 232. ISBN   978-1556426490.
  39. 1 2 3 4 Robertson, p. 159
  40. ↑ Digby GC, Daubney ME, Baggs J, Campbell D, Simpson CS, Redfearn DP, et al. (July 2009). "Physiotherapy and cardiac rhythm devices: a review of the current scope of practice". Europace. 11 (7): 850–859. doi: 10.1093/europace/eup102 . PMID   19411677.
  41. ↑ Watson, p. 265
  42. ↑ Hall JE, Guyton AC. Guyton and Hall textbook of medical physiology. OCLC   434319356 . Retrieved 29 March 2021– via Worldcat.
  43. ↑ Ebers K. "The 3 different TENS stimulation types". Axion. Retrieved 29 March 2021.
  44. ↑ Nnoaham KE, Kumbang J (July 2008). Nnoaham KE (ed.). "Transcutaneous electrical nerve stimulation (TENS) for chronic pain". The Cochrane Database of Systematic Reviews (3): CD003222. doi:10.1002/14651858.CD003222.pub2. PMID   18646088.
  45. ↑ "Transcutaneous Electrical Nerve Stimulation (TENS)". Physiopedia. Retrieved 29 March 2021.
  46. ↑ Jensen JE, Conn RR, Hazelrigg G, Hewett JE (1985). "The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery". The American Journal of Sports Medicine. 13 (1): 27–33. doi:10.1177/036354658501300105. PMID   3872082. S2CID   19217534.
  47. ↑ "Transcutaneous Electrical Nerve Stimulation: Side Effects & Uses".
  48. ↑ Dac Teoli, Jason An (2019). Transcutaneous Electrical Nerve Stimulation (TENS). StatPearls. PMID   30725873.
  49. ↑ Maurer, D "Transcutaneous stimulator and stimulation method" U.S. patent 3,817,254 , Publication date June 18, 1974
  50. ↑ Burton C (January 1974). "Instrumentation for dorsal column stimulator implantation". Surgical Neurology. 2 (1): 39–40. PMID   4810453.
  51. ↑ https://lethealth.us/about-us/history/
  52. ↑ Monaco A, Cattaneo R, Ortu E, Constantinescu MV, Pietropaoli D (May 2017). "Sensory trigeminal ULF-TENS stimulation reduces HRV response to experimentally induced arithmetic stress: A randomized clinical trial". Physiology & Behavior. 173: 209–215. doi:10.1016/j.physbeh.2017.02.014. PMID   28213205. S2CID   1816117.
  53. ↑ Cameron M, Lonergan E, Lee H (2003-07-21). "Transcutaneous electrical nerve stimulation (TENS) for dementia". The Cochrane Database of Systematic Reviews. 2003 (3): CD004032. doi:10.1002/14651858.CD004032. PMC   6768999 . PMID   12917999.
  54. ↑ Abraha I, Rimland JM, Trotta FM, Dell'Aquila G, Cruz-Jentoft A, Petrovic M, et al. (March 2017). "Systematic review of systematic reviews of non-pharmacological interventions to treat behavioural disturbances in older patients with dementia. The SENATOR-OnTop series". BMJ Open. 7 (3): e012759. doi:10.1136/bmjopen-2016-012759. PMC   5372076 . PMID   28302633.
  55. ↑ Schoenen J, Vandersmissen B, Jeangette S, Herroelen L, Vandenheede M, Gérard P, Magis D (February 2013). "Migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial". Neurology. 80 (8): 697–704. doi:10.1212/WNL.0b013e3182825055. hdl: 2268/216189 . PMID   23390177. S2CID   38716692.
  56. ↑ "FDA allows marketing of first medical device to prevent migraine headaches". fda.gov.
  57. 1 2 Liebano RE, Rakel B, Vance CG, Walsh DM, Sluka KA (February 2011). "An investigation of the development of analgesic tolerance to TENS in humans". Pain. 152 (2): 335–342. doi:10.1016/j.pain.2010.10.040. PMC   3027071 . PMID   21144659.
  58. ↑ Johnson MI, Paley CA, Jones G, Mulvey MR, Wittkopf PG (February 2022). "Efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for acute and chronic pain in adults: a systematic review and meta-analysis of 381 studies (the meta-TENS study)". BMJ Open. 12 (2): e051073. doi:10.1136/bmjopen-2021-051073. PMC   8845179 . PMID   35144946.
Books cited

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.