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(800)
Abstracts
E09 - TENS/Counterstimulation (800) Both high and low frequency TENS reduce postoperative visceral pain
S51 (802) High frequency TENS reduces pain intensity during the eletrolifiting procedure in the treatment of striae
J DeSantana, G Lauretti; University of Sa˜o Paulo, Ribeira˜o Preto, Brazil There are few studies about the effect of TENS in visceral pain in the literature. We performed a randomized, double-blinded and placebocontrolled study to analyze if TENS reduces postoperative visceral pain after tubal sterilization surgery. 60 women were divided in three groups (High Frequency TENS-HFT 100 Hz; Low Frequency TENS-LFT 4Hz, or Placebo TENS). TENS was applied next to umbilical cicatrice for 30 minutes immediately in the postoperative period when the patients arrived in the post anesthesia care unit (PACU). A numerical scale (10 cm) and the Brazilian version of the McGill Pain Questionnaire (Br-MPQ) were used to measure postoperative pain intensity before and after TENS application. Length of stay in the PACU was also measured. Data were analyzed through Kruskal Walis, Wilcoxon Matched Pairs and Post Hoc Tukey Tests. Data with p values ⬍0.05 were considered statistically significant. Postoperative pain intensity was reduced after application of either high and low frequency TENS when compared to placebo TENS (p⫽0.001) for the numerical rating scale and the Pain Rating Index of the Br-MPQ. The descriptors selected by the subjects were colic (100% report), frightful and troublesome. The patients selected equal proportions of descriptors between sensory and affective categories in all groups (p⫽0.002). Moreover, HFT group presented shorter stay in the PACU (p⬍0.05). The majority of the patients in all groups (90 to 100%) reported that the TENS was comfortable and they would use TENS again in another surgical procedure. This study suggests that both high and low frequency TENS reduce postoperative visceral pain after tubal sterilization procedure when this method is combined to analgesic drugs in the postoperative period.
J DeSantana, M Corroa, A Marcelino, A da Silva; University of Sa˜o Paulo, Ribeira˜o Preto, Brazil Eletrolifting is the method more used to treat striae. It’s a galvanic current which induces the inflammatory process due to penetration of the deep tissue. This technique usually causes uncomfortable somatic pain. Pharmacological or non-pharmacological treatments have not been studied for their ability to provide local analgesia during the eletrolifiting application. We evaluated the effect of TENS and EMLA (eutectic mixture of local anesthetic) as hypoalgesic resources in the treatment of striae during eletrolifiting. Fifteen women participated of this randomized, placebo-controlled, double-blinded study. The patients who underwent the eletrolifiting procedure received six types of treatment for local analgesia: Control (no EMLA, no TENS), EMLA, High Frequency TENS-HFT (100Hz), Low Frequency TENS-LFT (4 Hz), Mixed Frequency TENS-MFT and Placebo TENS. Pulse duration was 300ƒY´s and TENS was applied for 30 minutes in the spine muscles. When EMLA was required, the patients were informed to use it one hour before the therapy by placing on the skin surface. A numerical pain rating scale scale (NS), the visual analogue scale (VAS) and the McGill Pain Questionnaire (MPQ) were used to measure pain intensity 30 minutes after the eletrolifiting. Data were analyzed through Kruskal Walis, Wilcoxon Matched Pairs and Pos Hoc Tukey tests. Data with p values ⬍0.05 were considered statistically significant. Pain intensity on the NS (p⫽0.02) and VAS (p⫽0.03) was reduced when we used HFT and EMLA. In all treatment groups, the patients selected significantly major number of sensory descriptors (p⫽0,001). When the patients received HFT and EMLA, they chose less words in the sensory subcategory than the other treatments (p⬍0.05). This research suggests that high frequency TENS and EMLA produce local hypoalgesia. Consequently, this pain intensity reduction improves the comfort for the treatment of the striaes through the eletrolifiting.
(801) Transcutaneous electrical nerve stimulation: Neurophysiological outcomes in chronic low back pain patients
F. Treatment Approaches (Psychosocial & Cognitive)
A Fann, M Preston, R Skinner, E Garcia-Rill; Central Arkansas Veterans Healthcare System, Little Rock, AR Chronic low back pain (CLBP) is associated with attentional deficits. The goal of the study was to determine if stimulation with transcutaneous electrical nerve stimulation (TENS) modulated pre-attentional (measured by P50 Auditory Evoked Potential [AEP] studies), attentional (measured by Psychomotor Vigilance Task [PVT]) and frontal lobe function (determined by relative frontal lobe blood flow measured using Near Infrared Spectroscopy [NIRS]) in subjects with CLBP. We hypothesized that TENS would have a beneficial effect on the dysregulation of preattentional and attentional processes in patients with CLBP. Four subjects with CLBP only, 3 with CLBP and depression (DEP) and 3 with CLBP and post-traumatic stress disorder (PTSD) were recruited. The TENS electrodes were place over the lumbar region. Stimulation lasted 20 minutes. P50 AEPs were recorded prior to the EA stimulation and every 10 minutes for 50 minutes. The PVT was measured prior to and 30 minutes after the stimulation. NIRS was measured continuously throughout the stimulation and for 30 minutes after the stimulation. The ANOVA was used to determine when statistical significance (p20.05). P50 AEP amplitude decreased (decreased arousal level) during TENS in patients with CLBP only and CLBP⫹PTSD; P50 AEP habituation decreased (less sensory gating) during TENS in patients with CLBP⫹PTSD. PVT minimal responses (optimal response) increased in CLBP⫹DEP but decreased (improved) in CLBP only and CLBP⫹PTSD and lapse domain (slowest 10% of trials) increased after TENS in CLBP⫹PTSD. Relative NIRS values decreased with TENS in patients with CLBP⫹DEP but increased in patients with CLBP⫹PTSD. In patients with CLBP with and without PTSD, TENS 1) has a calming effect as determined by decreased P50 amplitude and P50 habituation; and 2) allows increased reaction time performance, perhaps by decreasing frontal lobe blood flow by allowing attentional mechanisms to target PVT performance. TENS has different effects on CLBP patients with co-morbidities.
F01 - Cognitive/Behavioral Approaches (803/Paper 318) Neither preventive medication nor behavioral migraine management improve optimal acute therapy outcomes, but their combination does: The Treatment of Severe Migraine (TSM) trial K Holroyd, C Cottrell, F O’Donnell, G Cordingley, J Drew, B Carlson, L Himawan, V Heh; Ohio University, Columbus and Athens, OH The TSM trial evaluated the ability of Preventive Drug Therapy (PDT) and Behavioral Migraine Management (BMM) separately and combined to improve outcomes with Optimal Acute Therapy (OAT) in frequent migraine. Potential trial participants with frequent migraine (IHS migraine, minimum of 3 migraines/mo., significant migrainerelated disability) completed a 5-week acute therapy (Triptans, NSAID, anti-emetic and, as needed, rescue medication) run-in. Ss with diary confirmed migraine frequency/disability despite acute therapy were randomized (N⫽232; 79% female; means, age ⫽ 38 migraines/mo.⫽ 6.3, migraine days/mo⫽ 8.1.) to the 4 experimental treatments. The four experimental treatments were: 1) OAT (social learning based education to maximize effective use of acute therapies) ⫹ Preventive Placebo (PL), 2) OAT ⫹ PDT (Propranolol LA (PR) to 240 mg/d. or, if ineffective or not tolerated, Nadalol (NA) to 120 mg./d.), 3) OAT ⫹ BMM ( migraine education, relaxation, thermal biofeedback or stress-management, pain management) ⫹ PL, and 4) OAT ⫹ BMM ⫹ PDT. Migraine activity and medication use was monitored by hand-held computer diary throughout the 16 mo. trial. Quality-of-Life (Headache Disability Inventory; HDI & Migraine Specific Quality of Life; MSQL) measures were collected periodically (mo. 0,1, 3,5,7,10,13,16).. Mixed models analysis (N ⫽ 232) revealed all 4 treatments produced substantial improvements across all outcome measures (p ⬍ .001), but the 4 treatments also differed in effectiveness (p ⬍ .001). Only the addition of BMM ⫹ PDT significantly improved migraine activity (episodes/mo, migraine days/mo.) beyond OAT alone (p ⬍ .01). However, both BMM ⫹ PDT and BMM alone improved outcomes on Q-of-L (HDI, MSQL) beyond both OAT alone and OAT ⫹ PDT. BMM ⫹ PDT optimally improved all outcomes obtained with OAT. OAT alone may effectively control migraines in up to 50% of Ss, raising the possibility that effective early abortion of migraine reduces the probability of migraine on subsequent days.
E09 - TENS/Counterstimulation (800) Both high and low frequency TENS reduce postoperative visceral pain
S51 (802) High frequency TENS reduces pain intensity during the eletrolifiting procedure in the treatment of striae
J DeSantana, G Lauretti; University of Sa˜o Paulo, Ribeira˜o Preto, Brazil There are few studies about the effect of TENS in visceral pain in the literature. We performed a randomized, double-blinded and placebocontrolled study to analyze if TENS reduces postoperative visceral pain after tubal sterilization surgery. 60 women were divided in three groups (High Frequency TENS-HFT 100 Hz; Low Frequency TENS-LFT 4Hz, or Placebo TENS). TENS was applied next to umbilical cicatrice for 30 minutes immediately in the postoperative period when the patients arrived in the post anesthesia care unit (PACU). A numerical scale (10 cm) and the Brazilian version of the McGill Pain Questionnaire (Br-MPQ) were used to measure postoperative pain intensity before and after TENS application. Length of stay in the PACU was also measured. Data were analyzed through Kruskal Walis, Wilcoxon Matched Pairs and Post Hoc Tukey Tests. Data with p values ⬍0.05 were considered statistically significant. Postoperative pain intensity was reduced after application of either high and low frequency TENS when compared to placebo TENS (p⫽0.001) for the numerical rating scale and the Pain Rating Index of the Br-MPQ. The descriptors selected by the subjects were colic (100% report), frightful and troublesome. The patients selected equal proportions of descriptors between sensory and affective categories in all groups (p⫽0.002). Moreover, HFT group presented shorter stay in the PACU (p⬍0.05). The majority of the patients in all groups (90 to 100%) reported that the TENS was comfortable and they would use TENS again in another surgical procedure. This study suggests that both high and low frequency TENS reduce postoperative visceral pain after tubal sterilization procedure when this method is combined to analgesic drugs in the postoperative period.
J DeSantana, M Corroa, A Marcelino, A da Silva; University of Sa˜o Paulo, Ribeira˜o Preto, Brazil Eletrolifting is the method more used to treat striae. It’s a galvanic current which induces the inflammatory process due to penetration of the deep tissue. This technique usually causes uncomfortable somatic pain. Pharmacological or non-pharmacological treatments have not been studied for their ability to provide local analgesia during the eletrolifiting application. We evaluated the effect of TENS and EMLA (eutectic mixture of local anesthetic) as hypoalgesic resources in the treatment of striae during eletrolifiting. Fifteen women participated of this randomized, placebo-controlled, double-blinded study. The patients who underwent the eletrolifiting procedure received six types of treatment for local analgesia: Control (no EMLA, no TENS), EMLA, High Frequency TENS-HFT (100Hz), Low Frequency TENS-LFT (4 Hz), Mixed Frequency TENS-MFT and Placebo TENS. Pulse duration was 300ƒY´s and TENS was applied for 30 minutes in the spine muscles. When EMLA was required, the patients were informed to use it one hour before the therapy by placing on the skin surface. A numerical pain rating scale scale (NS), the visual analogue scale (VAS) and the McGill Pain Questionnaire (MPQ) were used to measure pain intensity 30 minutes after the eletrolifiting. Data were analyzed through Kruskal Walis, Wilcoxon Matched Pairs and Pos Hoc Tukey tests. Data with p values ⬍0.05 were considered statistically significant. Pain intensity on the NS (p⫽0.02) and VAS (p⫽0.03) was reduced when we used HFT and EMLA. In all treatment groups, the patients selected significantly major number of sensory descriptors (p⫽0,001). When the patients received HFT and EMLA, they chose less words in the sensory subcategory than the other treatments (p⬍0.05). This research suggests that high frequency TENS and EMLA produce local hypoalgesia. Consequently, this pain intensity reduction improves the comfort for the treatment of the striaes through the eletrolifiting.
(801) Transcutaneous electrical nerve stimulation: Neurophysiological outcomes in chronic low back pain patients
F. Treatment Approaches (Psychosocial & Cognitive)
A Fann, M Preston, R Skinner, E Garcia-Rill; Central Arkansas Veterans Healthcare System, Little Rock, AR Chronic low back pain (CLBP) is associated with attentional deficits. The goal of the study was to determine if stimulation with transcutaneous electrical nerve stimulation (TENS) modulated pre-attentional (measured by P50 Auditory Evoked Potential [AEP] studies), attentional (measured by Psychomotor Vigilance Task [PVT]) and frontal lobe function (determined by relative frontal lobe blood flow measured using Near Infrared Spectroscopy [NIRS]) in subjects with CLBP. We hypothesized that TENS would have a beneficial effect on the dysregulation of preattentional and attentional processes in patients with CLBP. Four subjects with CLBP only, 3 with CLBP and depression (DEP) and 3 with CLBP and post-traumatic stress disorder (PTSD) were recruited. The TENS electrodes were place over the lumbar region. Stimulation lasted 20 minutes. P50 AEPs were recorded prior to the EA stimulation and every 10 minutes for 50 minutes. The PVT was measured prior to and 30 minutes after the stimulation. NIRS was measured continuously throughout the stimulation and for 30 minutes after the stimulation. The ANOVA was used to determine when statistical significance (p20.05). P50 AEP amplitude decreased (decreased arousal level) during TENS in patients with CLBP only and CLBP⫹PTSD; P50 AEP habituation decreased (less sensory gating) during TENS in patients with CLBP⫹PTSD. PVT minimal responses (optimal response) increased in CLBP⫹DEP but decreased (improved) in CLBP only and CLBP⫹PTSD and lapse domain (slowest 10% of trials) increased after TENS in CLBP⫹PTSD. Relative NIRS values decreased with TENS in patients with CLBP⫹DEP but increased in patients with CLBP⫹PTSD. In patients with CLBP with and without PTSD, TENS 1) has a calming effect as determined by decreased P50 amplitude and P50 habituation; and 2) allows increased reaction time performance, perhaps by decreasing frontal lobe blood flow by allowing attentional mechanisms to target PVT performance. TENS has different effects on CLBP patients with co-morbidities.
F01 - Cognitive/Behavioral Approaches (803/Paper 318) Neither preventive medication nor behavioral migraine management improve optimal acute therapy outcomes, but their combination does: The Treatment of Severe Migraine (TSM) trial K Holroyd, C Cottrell, F O’Donnell, G Cordingley, J Drew, B Carlson, L Himawan, V Heh; Ohio University, Columbus and Athens, OH The TSM trial evaluated the ability of Preventive Drug Therapy (PDT) and Behavioral Migraine Management (BMM) separately and combined to improve outcomes with Optimal Acute Therapy (OAT) in frequent migraine. Potential trial participants with frequent migraine (IHS migraine, minimum of 3 migraines/mo., significant migrainerelated disability) completed a 5-week acute therapy (Triptans, NSAID, anti-emetic and, as needed, rescue medication) run-in. Ss with diary confirmed migraine frequency/disability despite acute therapy were randomized (N⫽232; 79% female; means, age ⫽ 38 migraines/mo.⫽ 6.3, migraine days/mo⫽ 8.1.) to the 4 experimental treatments. The four experimental treatments were: 1) OAT (social learning based education to maximize effective use of acute therapies) ⫹ Preventive Placebo (PL), 2) OAT ⫹ PDT (Propranolol LA (PR) to 240 mg/d. or, if ineffective or not tolerated, Nadalol (NA) to 120 mg./d.), 3) OAT ⫹ BMM ( migraine education, relaxation, thermal biofeedback or stress-management, pain management) ⫹ PL, and 4) OAT ⫹ BMM ⫹ PDT. Migraine activity and medication use was monitored by hand-held computer diary throughout the 16 mo. trial. Quality-of-Life (Headache Disability Inventory; HDI & Migraine Specific Quality of Life; MSQL) measures were collected periodically (mo. 0,1, 3,5,7,10,13,16).. Mixed models analysis (N ⫽ 232) revealed all 4 treatments produced substantial improvements across all outcome measures (p ⬍ .001), but the 4 treatments also differed in effectiveness (p ⬍ .001). Only the addition of BMM ⫹ PDT significantly improved migraine activity (episodes/mo, migraine days/mo.) beyond OAT alone (p ⬍ .01). However, both BMM ⫹ PDT and BMM alone improved outcomes on Q-of-L (HDI, MSQL) beyond both OAT alone and OAT ⫹ PDT. BMM ⫹ PDT optimally improved all outcomes obtained with OAT. OAT alone may effectively control migraines in up to 50% of Ss, raising the possibility that effective early abortion of migraine reduces the probability of migraine on subsequent days.