A randomized trial comparing the Tennant Biomodulator to transcutaneous electrical nerve stimulation and traditional Chinese acupuncture for the treatment of chronic pain in military service members

Background:The present investigation tested the efficacy of the Tennant Biomodulator,a novel pain management intervention that uses biofeedback-modulated electrical stimulation,to reduce chronic pain and its psychosocial sequelae in a sample of current and former military service members.The Tennant Biomodulator used on its most basic setting was compared to two commonly used,non-pharmacological pain treatments—traditional Chinese acupuncture and transcutaneous electrical nerve stimulation(TENS)—in a comparative efficacy,randomized,open-label trial.Methods:Participants included 100 active duty and retired service men and women with chronic pain undergoing treatment at the Brooke Army Medical Center in Texas,USA,randomly assigned to receive six,weekly sessions of either Tennant Biomodulator treatment,traditional Chinese acupuncture,or TENS,in addition to usual care.Recruitment was conducted between May 2010 to September 2013.Outcome measures were collected at intake,before and after each treatment session,and at a 1-month follow-up.Intent-to-treat analyses were used throughout,with mixed models used to investigate main effects of group,time,and group×time interactions with consideration given to quadratic effects.Outcomes measured included ratings of chronic pain,pain-related functional disability,and symptoms of post-traumatic stress disorder(PTSD)and depression.Results:On average,regardless of their treatment group,participants exhibited a 16%reduction in pain measured by the Brooke Army Medical Center’s Clinic Pain Log[F(1,335)=55.7,P<0.0001]and an 11%reduction in pain-related disability measured by the Million Visual Analog Scale[MVAS:F(1,84)=28.3,P<0.0001]from baseline to the end of treatment,but no one treatment performed better than the other,and the reductions in pain and pain-related disability were largely lost by 1-month follow-up.Symptoms of PTSD and depression did not change significantly as a function of time or group.Conclusions:Findings build on previous work suggesting that traditional Chinese acupuncture and TENS can reduce pain and its functional sequelae without risks associated with pharmacological pain management.The Tennant Biomodulator used on its most basic setting performs as well as these other interventions.Based on the present findings,large,randomized controlled trials on the Tennant Biomodulator are indicated.Future work should test this device using its full range of settings for pain-related psychological health.Trial registration:Clincialtrials.gov(NCT01752010);registered December 14,2012.

Non-invasive transcutaneous electrical stimulation in the treatment of overactive bladder

We reviewed the literature on transcutaneous electrical nerve stimulation(TENS)used as a therapy for overactive bladder(OAB)symptoms,with a particular focus on:stimulation site,stimuli parameters,neural structures thought to be targeted,and the clinical and urodynamic outcomes achieved.The majority of studies used sacral or tibial nerve stimulation.The literature suggests that,whilst TENS therapy may have neuromodulation effects,patient are unlikely to benefit to a significant extent from a single application of TENS and indeed clear benefits from acute studies have not been reported.In long-term studies there were differences in the descriptions of stimulation intensity,strategy of the therapy,and positioning of the electrodes,as well as in the various symptoms and pathology of the patients.Additionally,most studies were uncontrolled and hence did not evaluate the placebo effect.Little is known about the underlying mechanism by which these therapies work and therefore exactly which structures need to be stimulated,and with what parameters.There is promising evidence for the efficacy of a transcutaneous stimulation approach,but adequate standardisation of stimulation criteria and outcome measures will be necessary to define the best way to administer this therapy and document its efficacy.

Evaluating the Impact of Transcutaneous Electrical Nerve Stimulation on Patients Undergoing Inguinal Hernia Surgery: A Meta- Analysis of Randomized Controlled Trials

Objective:A comprehensive meta-analysis based on the latest randomized controlled trials(RCTs)was conducted to investigate the effects of transcutaneous electrical nerve stimulation(TENS)on patients undergoing treatment after inguinal hernia surgery.Methods:A detailed search of Embase,PubMed,Web of Science,and the Cochrane Library was performed for RCTs investigating the use of TENS during inguinal hernia surgery up to September 28,2021.The Cochrane tool was applied to assess the risk of bias in the included studies.Results:Seven eligible RCTs with a total of 379 cases were included.The meta-analysis showed a mean difference(MD)in VAS of-1.61[95%CI:-2.20-1.02,P<0.00001]at 2 hours post-operation,VAS MD=-1.33 at 4 hours post-operation[95%CI:-2.84-0.18,P=0.09],VAS MD=-2.36 at 8 hours post-operation[95%CI:-4.04-0.69,P=0.006],and VAS MD=-1.75 at 24 hours post-operation[95%CI:-2.64-0.85,P=0.0001].The cortisol level MD at 24 hours post-operation was-52.56[95%CI:-168.8-63.76,P=0.38].Conclusion:TENS significantly reduces postoperative pain following inguinal hernia surgery and promotes patient recovery.TENS is recommended for patients undergoing inguinal hernia surgery.However,further high-quality studies are needed to confirm additional effects.

Effect of transcutaneous electrical nerve stimulation at acupoints on patients with type 2 diabetes mellitus:a randomized controlled trial

OBJECTIVE:To examine whether transcutaneous electric nerve stimulation at acupoints(Acu-TENS)improved the biochemical and physical indices of patients with type 2 diabetes mellitus(T2DM).METHODS:Ninety subjects with T2DM were divided randomly into a control group(n = 30),aerobic exercise group(n- 30),or Acu-TENS group(n = 30).In addition to conventional diabetes drug treatment,patients in the Acu-TENS group received acupoint stimulation,the aerobic exercise group engaged in walking exercises,and the control group was given sham electrical stimulation.All groups were treated for 30 min for each session and five times a week for 2 months.The indices of glycosylated hemoglobin,2 h postprandial glucose,fasting serum insulin,triglyceride,total cholesterol,and body mass index were assessed at pre-treatment,post-treatment,and follow-up,which was 2 months after treatment.RESULTS:The indices of the control group were not changed(P > 0.05) at the three time points.At the pre-treatment measurement,there were significant differences(P > 0.05) in indices among the three groups.At post-treatment,each index of the two groups was lower than that of the control group(P < 0.05),and improved in comparison with the pre-treatment measurement(P < 0.05).In follow-up,each index of the aerobic exercise group and Acu-TENS group increased,but was still decreased compared with the pre-treatment value(P < 0.05),excluding body mass index.CONCLUSION:Acu-TENS could improve the state of patients with T2 DM and be used as a therapy in clinical application.

Transcutaneous Electrical Nerve Stimulation on Acupoints Relieves Labor Pain:A Non-randomized Controlled Study

Objective：To investigate the efficacy of transcutaneous electrical nerve stimulation（TENS）on four specific acupuncture points Hegu（LI4）,Neiguan（PC6）,Danshu（BL19）and Weishu（BL21）for reducing pain in labor.Methods：A total of 160 voluntary nulliparous women who were willing to receive TENS for analgesia were assigned to the treatment group after cervical dilation of more than 2 cm.Another 145 matched nullipara were recruited as the control group.Visual analogue scale（VAS）was used to assess the pain before and 0.5 h after the application of TENS.Then,VAS was assessed every one hour until delivery.Percentage of VAS score decreased by〉25%was the primary outcome,the delivery mode and neonatal outcome were measured as secondary outcomes.Adverse reactions were also recorded during TENS.Results：The percentage of VAS score decreased by〉25%was 68.6%in the TENS treatment group.Maternal delivery mode and neonatal outcomes were not significantly different between the two groups.In addition,the incidence of postpartum hemorrhage in the TENS treatment group was less than the control group（P〈0.05）.There was no adverse reaction recorded with TENS on acupoints.Conclusion：As a novel and non-invasive approach,TENS on specific acupoints including Hegu（LI4）,Neiguan（PC6）,Danshu（BL19）and Weishu（BL21）was an effective method for analgesia in labor.

Effect of transcutaneous electrical nerve stimulation through acupoints of Pucan (BL 61) and Shenmai (BL 62) on intraocular pressure in patients with glaucoma： a randomized controlled trial

OBJECTIVE： To investigate the effects of transcutaneous electrical nerve stimulation （TENS） through acupoints on the intraocular pressure （lOP） in patients with glaucoma. METHODS： A single-blinded, randomized experimental design study was conducted. Patients from the North of Taipei Ophthalmology outpatient department diagnosed with intraocular hypertension were selected and were further enrolled if they met the research subject criteria. The patients who met all criteria, and who met no exclusion criteria became the participants. Participants were randomly assigned into the treated group, wherein the TENS electrodes （Qing Ming Medical Device Co., Ltd., New Taipei City, China） were applied with direct current （DC） on the acupoints Pucan （BL 61） and Shenmai （BL 62） for 20 min. The control group received no TENS electrode treatments. Measurements of lOP were taken four times using a pneumotonometer （Clinico Co., Ltd., New Taipei City, China）, before, immediately after, 30 min after, and 60 min after TENS electrode treatments. RESULTS： Eighty-two participants completed the experiment, lOP decreased more in the group treated with DC （P 〈 0.01） than in the control group.The lOPs were not affected by the age of the patients and their usage of medications. CONCLUSION： TENS of acupoints of Pucan （BL 61） and Shenmai （BL 62） could significantly reduce the lOP in patients with glaucoma.

Non-invasive stimulation techniques to relieve abdominal/pelvic pain: Is more always better?

Chronic abdominal and pelvic pain is a common condition that has significant impact on quality of life,and causes billions of dollars in direct and indirect costs.Emerging data suggest that transcranial direct current stimulation(t DCS),alone or in combination with transcutaneous electrical nerve stimulation(TENS),could be a promising therapeutic avenue to reduce chronic pain.The encouraging results coming from these studies prompted us to try combining TENS and t DCS in 4 of our patients who suffered from chronic abdominal/pelvic pain and to compare the effect with 5other patients who received TENS alone.Pain intensity was assessed with a visual analog scale before,during and after the stimulation.We observed that there was a slight decrease in pain which was similar in both patient groups(TENS alone and TENS combined with t DCS).These observations suggest that combining TENS and t DCS in patients suffering from chronic pelvic and/or abdominal pain produces no additional benefit,compared to TENS alone.Future studies,looking at the effect of several/consecutive TENS and t DCS sessions should be conducted.

Effect of acupuncture-like transcutaneous electrical nerve stimulation on labor pain in nulliparous women:a randomized controlled trial

Objective To examine the effect of acupuncture-like transcutaneous electrical nerve stimulation(ACUTENS)on labor pain in nulliparous women.Methods This randomized clinical trial was conducted at Razi Hospital in Qazvin,Iran between January and July 2018.After the screening process,144 out of 184 pregnant women were selected by convenience sampling and assigned to an intervention group or a control group by the block randomization method.The intervention group received ACUTENS at Hegu(LI4),Shenmen(HT7),Sanyinjiao(SP6),and Neimadian(Extra)during various stages of delivery in addition to routine labor care at the delivery room.For the control group,the same routine labor care was performed alone.The severity of pain was assessed in the two groups using the visual analog scale(VAS).The data were analyzed using R software(ver.4.0.2)and repeated measurement analysis of variance.Results ACUTENS reduced the mean score of pain intensity in the first stage of labor in the intervention group more than that in the control group(P<0.001).Also,the mean scores of pain intensity in the second stage of labor,episiotomy,and one hour after delivery in the intervention group were significantly lower than those in the control group(P<0.001).Conclusion ACUTENS at Hegu(LI4),Shenmen(HT7),Sanyinjiao(SP6),and Neimadian(Extra)can decrease the intensity of labor pain in nulliparous women.It can be used as a non-pharmacological method for reducing pain in and after labor.

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION FOR TREATMENT OF SPINAL SPASTICITY

Thirty-two patients with spinally originated muscle spasticity were treated with a transcutaneous electrical nerve

Neural Firing Mechanism Underlying Two-Electrode Discrimination by 3D Transcutaneous Electrical Nerve Stimulation Computational Model

Transcutaneous electrical nerve stimulation(TENS) has been widely used for sensory feedback which is a key consideration of improving the performance of prosthetic hands. Two-electrode discriminability is the key to realize high-spatial-resolution TENS, but the neural firing mechanism is not clear yet. The goal of this research is to investigate the neural firing patterns under two-electrode stimulation and to reveal the potential mechanisms. A three-dimensional(3 D) model is established by incorporating Aβ fiber neuron clusters into a layered forearm structure. The diameters of the stimulating electrodes are selected as 5, 7, 9 and 12 mm, and the two-electrode discrimination distance(TEDD) is quantified. It is found that a distant TEDD is obtained for a relatively large electrode size, and 7 mm is suggested to be the optimal diameter of stimulating electrodes. The present study reveals the neural firing patterns under two-electrode stimulation by the 3 D TENS model. In order to discriminate individual electrodes under simultaneous stimulation, no crosstalk of activated Aβ fibers exists between two electrodes. This research can further guide the optimization of the electrode-array floorplan.

Efficacy of transcutaneous electrical acupoint stimulation(TEAS)for menopausal insomnia and its effect on serum hormone levels

Objective:To explore the therapeutic efficacy and mechanism of transcutaneous electrical acupoint stimulation(TEAS)for menopausal insomnia.Methods:A total of 80 patients with menopausal insomnia were randomly divided into a control group and an observation group,with 40 cases in each group.The patients in the control group received conventional Western medication treatment,and the patients in the observation group received TEAS on the basis of conventional Western medication treatment.The treatment for both groups lasted for 4 weeks.Before and after treatment,Pittsburgh sleep quality index(PSQI)and modified Kupperman scale were evaluated,and the serum levels of estradiol(E2)and follicular stimulating hormone(FSH)were measured.The therapeutic efficacy was evaluated after treatment.Results:After treatment,the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);in the control group,the improvement of PSQI score was significant(P<0.05),while the change of modified Kupperman score was insignificant(P>0.05);the PSQI and Kupperman scores in the observation group were significantly improved after treatment(both P<0.05),and there were significant differences between the observation group and the control group in PSQI and Kupperman scores(both P<0.05).After treatment,the serum E2 and FSH levels in the control group were not statistically different from those before treatment(both P>0.05);the serum E2 level was significantly increased(P<0.05),and the FSH level was decreased(P<0.05)in the observation group after treatment,and the between-group differences in serum levels of E2 and FSH were significant(both P<0.05).Conclusion:TEAS plus conventional Western medication in treating menopausal insomnia is effective,and can significantly improve the symptoms of insomnia and menopause,which may be related to the regulation of serum E2 and FSH levels.

Observation on therapeutic effect of half puncture plus transcutaneous acupoint electric stimulation for infantile facial paralysis

Objective：To observe the clinical effects of half puncture plus transcutaneous acupoint electric stimulation in the treatment of infantile facial paralysis. Methods：A total of 60 patients with infantile facial paralysis were divided into a treatment group and a control group by the random digital table, 30 cases in each group. The treatment group was treated with half puncture plus transcutaneous acupoint electric stimulation. The control group was treated with routine acupuncture. Before and after treatment, House-Brackmann （H-B） grading was used to evaluate the sick children respectively. The total effective rates were compared between the two groups after treatment. Results：After 6-course treatments, the total effective rate was 96.5% in the treatment group and 80.0% in the control group, there was a statistical difference between the two groups （P〈0.05） in comparison of the total effective rate. After 6-course treatments, H-B scores were all elevated than those before treatment in the two groups （P〈0.05）; there was a statistical difference between the two groups （P〈0.05）. Conclusion：Half puncture plus transcutaneous acupoint electric stimulation is better than routine acupuncture in curative effect for infantile facial paralysis.

Efficacy of transcutaneous tibial nerve stimulation in the treatment of bladder pain syndrome

Background:This study aimed to demonstrate the effectiveness of transcutaneos tibial nerve stimulation(TTNS)in the treatment of bladder pain syndrome(BPS).Materials and methods:The data of 16 female patients,diagnosed with BPS in our clinic between 2019 and 2021 and had TTNS twice a week for 12 weeks,were retrospectively analyzed.Results:The mean age of the patients was 46.00±13.11 years,and the mean body mass index was 26.43±3.07 kg/m^(2).After the treatment,the median day time frequency of the patients decreased from 13.37(3.69)to 10.25(4.56)(p<0.001).Nocturia also decreased after treatment from 4.37(1.81)to 3.00(1.94)(p=0.001).The median voiding volume increased by 26.5 mL(p=0.001).The median of the patients'visual analog scale scores decreased after treatment(median of visual analog scale score changed from interquartile range 8[1]to 7[4])(p=0.001).In addition,the median interquartile range interstitial cystitis symptom index scores decreased from 17(4)to 15(10)(p=0.002).Conclusions:In this study it was demonstrated that TTNS is an alternative method that can be successfully applied before invasive methods in the treatment of BPS.

Overview of reported transcutaneous electrical acupoint stimulation effects on pain mediators

Literatures on pain intervention with transcutaneous electrical acupoint stimulation(TEAS)were collected by searching the databases both in Chinese and English,and summarized to understand the research progress of TEAS effects on pain mediators in recent years.This will provide a more objective and scientific theoretical basis for clinical practice of TEAS to treat pain syndrome,thus promoting the clinical application of TEAS.Our literature analysis indicated that TEAS effectively regulated the release levels of various pain factors such as prostaglandin,5-hydroxytryptamine,interleukins,substance P and tumor necrosis factor-αto achieve the analgesic effects by affecting the conduction pathways.TEAS is a safe,non-invasive and effective treatment for pain syndrome.However,further research is necessary due to the lack of rigor of the current clinical trial design.

Treatment of Early-stage Adhesive Shoulder Periarthritis with Transcutaneous Electric Stimulation on Acupoints

Objective： To observe the therapeutic effects of transcutaneous electric acupoint stimulation on early-stage adhesive shoulder periarthritis. Methods： by using the research approach of evidence-based medicine such as multi-center, large sample and randomization, the 163 cases of early-stage adhesive shoulder periarthritis were treated with transcutaneous electric point stimulation and electric acupuncture respectively to observe the therapeutic effect of transcutaneous electric acupoint stimulation and compare its effect with electric acupuncture. Results and Conclusion： The total effective rate of transcutaneous electric point stimulation on early-stage adhesive shoulder periarthritis reached 96.5%, showing no significant difference with the electric acupuncture group; the transcutaneous electric acupoint stimulation could not only relieve pain, but also improve the shoulder joint movement. As a result, the transcutaneous electric acupoint stimulation is an easy and more effective therapy for shoulder periarthritis.

Influence of Transdermal Electric Stimulation of Neiguan(PC 6)On TCD in Patients with Acute Migraine

Purpose： In order to explore the clinical mechanism of Neiguan （PC 6） in the treatment of acute seizure of migraine and the relationship between Neiguan （PC 6） and cerebral blood flow. Methods： Clinically, 30 cases of the patients with acute seizure of migraine （ascending phase） were selected, in TCD abnormality, and divided randomly into the treatment group and control group, 15 cases in each group. In acute seizure of migraine, Neiguan （PC 6） was punctured with electric stimulation on the healthy side of the patients in the treatment group and Xuehai （SP 10） was punctured with electric stimulation on the healthy side of the patients in the control group. TCD was determined in the patients 30 min before and after the treatment. Results and conclusion： After transdermal electric stimulation on Neiguan （PC 6）, the velocity of intracranial blood flow was obviously slowed down, indicating that transdermal electric stimulation on Neiguan （PC 6） can effectively relieve the spasm of intracranial blood vessels and also shows its relative specificity.

Effects of medically generated electromagnetic interference from medical devices on cardiac implantable electronic devices: A review

As cardiac implantable electronic devices(CIED)become more prevalent,it is important to acknowledge potential electromagnetic interference(EMI)from other sources,such as internal and external electronic devices and procedures and its effect on these devices.EMI from other sources can potentially inhibit pacing and trigger shocks in permanent pacemakers(PPM)and implantable cardioverter defibrillators(ICD),respectively.This review analyzes potential EMI amongst CIED and left ventricular assist device,deep brain stimulators,spinal cord stimulators,transcutaneous electrical nerve stimulators,and throughout an array of procedures,such as endoscopy,bronchoscopy,and procedures involving electrocautery.Although there is evidence to support EMI from internal and external devices and during procedures,there is a lack of large multicenter studies,and,as a result,current management guidelines are based primarily on expert opinion and anecdotal experience.We aim to provide a general overview of PPM/ICD function,review documented EMI effect on these devices,and acknowledge current management of CIED interference.

Comparative assessment of efficacy and safety of different treatment for de novo overactive bladder children: A systematic review and network meta-analysis

Objective:To compare these managements focusing on the efficacy and safety to treat overactive bladder(OAB)in children through network meta-analysis(NMA).Methods:We searched PubMed,Embase,the Cochrane Library Central Register of Controlled Trials(CENTRAL)and the reference lists up to May 1st,2017.Data from eligible randomized controlled trails(RCT)studies including three different treatment options were extracted.The primary outcome was maximal voiding volume(MVV).We performed pairwise metaanalyses by random effects model and NMA by Bayesian model.We used the Grading of Recommendations,Assessment,Development and Evaluations(GRADE)framework to assess the quality of evidence contributing to each network estimate.Results:Six RCTs(462 patients)comparing three different interventions fulfilled the inclusion criteria.A low risk of bias was shown for the majority of the study items.The results of NMA showed that compared with antimuscarinic drugs,Parasacral transcutaneous electrical nerve stimulation was associated with significant improvement in the MVV(mean difference[MD]=58.50,95% confidential interval[CI]:45.95-69.52),followed by urotherapy group(MD=21.03,95%CI:11.85-29.97).When it comes to the constipation,antimuscarinic drugs exerted significant benefit than PTENS(odds ratio[OR]:0.22,95%CI:0.01-0.46).No significant difference was found between other treatments.Conclusion:Compared with antimuscarinic drugs,PTENS was associated with significant better efficacy considering MVV,but more constipation events in de novo OAB children.Antimuscarinic drugs showed remarkably better efficacy considering MVV and comparable safety profile compared with urotherapy.Clinicians should take all known safety and compliance of patients into account when choosing an optimal strategy.

Review on Tactile Sensory Feedback of Prosthetic Hands for the Upper-Limb Amputees by Sensory Afferent Stimulation

Loss of sensory function for upper-limb amputees inevitably devastates their life qualities, and lack of reliable sensory feedback is the biggest defect to sophisticated prosthetic hands, greatly hindering their usefulness and perceptual embodiment. Thus, it is extremely necessary to accomplish an intelligent prosthetic hand with effective tactile sensory feedback for an upper-limb amputee. This paper presents an overview of three kinds of existing sensory feedback approaches, including cutaneous mechanical stimulation(CMS), transcutaneous electrical nerve stimulation(TENS) and direct peripheral nerve electrical stimulation(DPNES). The emphasis concentrates on major scientific achievements, advantages and disadvantages. The TENS on the skin areas with evoked finger sensation(EFS) at upper-limb amputees' residual limbs might be one of the most promising approaches to realize natural sensory feedback.

Regional homogeneity analysis on acupoint specificity with resting-state functional magnetic resonance imaging

Background The mechanism of acupuncture analgesia in craniotomy has been widely studied. However, the theoretical basis for selection of acupoints has not been examined. In this study, we used the regional homogeneity method blood oxygen level-dependent （BOLD） signals to determine changes in brain activity in response to transcutaneous electrical stimulation on acupoints and non-acupoints in resting state functional magnetic resonance imaging （fMRI）.Methods Twelve healthy volunteers were enrolled in this study. BOLD fMRI scanning of the brain was performed for 306 seconds before and 30 minutes after transcutaneous electrical stimulation on acupoints UB63 （Jinmen）, LV3 （Tai chong）, ST36 （Zusanli）, and GB40 （Qiuxu）. The procedure was repeated after one week with stimulation on non-acupoints （one was 9 above BL67, the second was 12 above BL67 （Kunlun）, the third was 7 above KI3, and the fourth was 10 above KI3 （Taixi））.Results The regional homogeneity in the acupoint group was increased in the left thalamus, caudate, putamen, lentiform nucleus （BA19, 30, 39）, postcentral gyrus, precentral gyrus （BA3, 4, 30, 32）, calcarine fissure, middle temporal gyrus （BA30）, right superior temporal gyrus, inferior temporal gyrus （BA38）, cuneus, and precuneus （BA7, 19） when compared to the non-acupoint group. The regional homogeneity of the acupoint group was decreased in the left cerebellum posterior lobe, middle frontal gyrus （BA10）, double-side precuneus （BA7）, and the postcentral gyrus （BA40）.Conclusions The brain region activated following acupoint stimulation is the ipsilateral pain-related brain region, which may relate to the therapeutic effect of acupuncture on pain relief. Further acupoint stimulation causes different central nervous responses compared to non-acupoint stimulation.