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.

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.

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.

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.

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.

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.

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.