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839 EFFICIENCY OF TENS TREATMENTS IN HEMIPLEGIC SHOULDER PAIN: A PLACEBO CONTROLLED STUDY
S218
European Journal of Pain 2006, Vol 10 (suppl S1)
Abstracts, 5th EFIC Congress, Free Presentations
838 TENS AS ADDITIONAL TREATMENT OPTION FOR NAUSEA AND VOMITING IN PALLIATIVE CARE – A CASE REPORT
840 TENS IN CHRONIC PAIN: JUST PAIN REDUCTION AS AN OUTCOME?
G. Bollig ° . Department of Palliative Care, Bergen Red Cross Nursing home, Bergen, Norway
A.J. K¨oke1,2 ° , J.W. Vlaeyen3 , R. Perez4 , M. van Kleef1 , J. Patijn1 . Management and Research Center, University Hospital Maastricht, Maastricht, 2 Rehabilitation Foundation Limburg, Hoensbroek, 3 Department of Medical, Clinical and Experimental Psychology, University of Maastricht, Maastricht, 4 Department of Anesthesiology, VU University medical center, Amsterdam, The Netherlands
Background: Several studies have shown that acupuncture point stimulation is an effective treatment for nausea and vomiting in pregnancy, the postoperative period, cancer and chemotherapy-induced nausea and vomiting. The acupuncture point P6 can be activated by acupuncture, TENS (transcutaneous electrical nerve stimulation) and other methods. A recent review has questioned the effect of non-invasive electrostimualtion when state-of-the-art pharmacologic antiemetic therapy is provided. Method: A case report of a patient resistant to pharmacologic treatment of nausea and vomiting is presented. Results: The case of a 79-year old female patient who had breast cancer on the right side with metastases to the spine and head is presented. Her major complaint was nausea and vomiting that could not be treated by state-of-the-art pharmacological antiemetic therapy. On admission to our palliative care unit she scored 9/10 for nausea on the ESAS-scale. After starting cyclizine 50 mg 3 times daily and additional TENSstimulation of the acupuncture point P6 with 2 Hertz for 30 minutes twice a day the nausea vanished (0/10). On one occasion the patient failed to place the electrode correctly over the point P6. On that day she complained again about nausea (4/10). After instruction of the patient and proper acupuncture point location nausea symptoms vanished after 20 minutes with TENS-stimulation on P6. Conclusion: This case reports shows that TENS has a place in the treatment of nausea and vomiting in palliative care. It showed to be effective in a patient who could not be treated effectively by pharmacological antiemetic therapy alone.
839 EFFICIENCY OF TENS TREATMENTS IN HEMIPLEGIC SHOULDER PAIN: A PLACEBO CONTROLLED STUDY A. Ekim ° , O. Armagan, C. Oner. Department of Physical Therapy and Rehabilitation, Osmangazi University Faculty of Medicine, Eskisehir, Turkey Objective: The aim of the present study was to evaluate the efficacy transcutaneous electrical nerve stimulation (TENS) treatment on shoulder pain in hemiplegic patients. Material and Methods: We studied a total of 19 hemiplegic patients with painful shoulder. The patients were randomly assigned into Group 1 (n = 10, TENS) and Group 2 (n = 9, placebo TENS). In Group 1, patients were given high-intensity TENS for 10 sessions. In Group 2, placebo TENS was given for the same period. All patients received conventional rehabilitation based on the Brunnstrom concept. Clinical assessments were performed at baseline, at the end of the treatment in all patients. The shoulder passive range of motion (PROM), and the visual analog scale (VAS), the Modified Rankin Scale and Functional Independence Measure, and Ashworth scale were performed to evaluate the Clinical and neurophysiological parameters. Results: Clinical and neurophysiological parameters were similar at baseline in both groups. In both groups significant improvements were observed in VAS after treatment (p < 0.001, p < 0.05 respectively). PROM for abduction and external rotation significant improvements were observed in hemiplegic shoulder in only group 1 after treatment (p < 0.001, p < 0.001 respectively). A comparison between the groups showed significant improvements in only VAS and PROMs in favor of group 1 after therapy (p < 0.05, p < 0.05 respectively). Conclusions: Our study results indicated that TENS seem to be effective in pain and shoulder PROMs in hemiplegic patients. We, therefore, suggest that TENS could be used as a good alternative therapy method on shoulder pain in hemiplegic patients.
1 Pain
Background and Aim: Studies on the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) mainly focus on pain reduction as primary outcome. Reports of secondary effects of TENS such as; reduction of medication intake, increase in level of activity, and improved work capacity, are sparse. Long-term use of TENS might not solely due to pain reduction. The aim of our study is to investigate effectiveness of TENS beyond the domain of pain reduction. Method: In a prospective cohort the effectiveness of TENS in chronic pain was evaluated. After 6 months two subgroups were distinguished: ‘users’ (patients continuing TENS) and ‘nonusers’ (patients stopped using TENS). Besides pain reduction (Visual Analogue Scale; VAS), we evaluated: physical functioning (Short Form-36), work status, health care utilization, self-efficacy beliefs (Chronic Pain Self Efficacy Questionnaire; CPSEQ) and pain coping (Pain Coping and Cognition List; PCCL). Results: Of the 180 patients included, 149 returned for follow-up measurements at 6 months. 75 patients were in the users-group compared to 74 in nonusers-group. The users-group had statistically significant better improvements compared to nonusers-group: • pain reduction (VAS): 28% vs 0% • higher physical functioning (SF-36): 33% vs 11% • less health care utilization: – stop pain medication: 44% vs 25% – non current treatment: 50% vs 22% • higher self efficacy beliefs (CPSEQ: 22% vs 3%) • less catasthrophizing (PCCL): 11% vs 2% Conclusion: Besides pain reduction TENS is effective in increasing physical functioning, self-efficacy beliefs and decreasing health care utilization and catasthrophizing thoughts.
841 REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION AND PAIN RELIEF: THETA BURST STIMULATION A. Oliviero ° , M. Rubio-Esteban, A. Vari, J. De Andres, J.L. Diaz, J.M. Gomez-Arguelles, F. Sebastian de la Cruz, Y. Perez-Borrego. Hospital Nacional de Paraplejicos, Toledo, Spain The present study investigated whether five consecutive days of rTMS would lead to lasting pain relief in chronic intractable neuropathic pain. Eighteen patients with therapy resistant chronic pain syndromes participated. They received 40 seconds real rTMS over the hand area of motor cortex bilaterally (cTBS, 2×20 s trains, intensity 80% of motor threshold) every day for five consecutive days. Patients received, in a different session of 5 days, sham stimulation. Pain was assessed using a visual analogue scale (VAS). Real and sham rTMS had different effects on the VAS. RealrTMS led to a greater improvement in scales than sham-rTMS, evident even two weeks after the end of the treatment. No patient experienced severe adverse effects. These results confirm that five daily sessions of rTMS over motor cortex can produce longlasting pain relief in patients with neuropathic pain.
European Journal of Pain 2006, Vol 10 (suppl S1)
Abstracts, 5th EFIC Congress, Free Presentations
838 TENS AS ADDITIONAL TREATMENT OPTION FOR NAUSEA AND VOMITING IN PALLIATIVE CARE – A CASE REPORT
840 TENS IN CHRONIC PAIN: JUST PAIN REDUCTION AS AN OUTCOME?
G. Bollig ° . Department of Palliative Care, Bergen Red Cross Nursing home, Bergen, Norway
A.J. K¨oke1,2 ° , J.W. Vlaeyen3 , R. Perez4 , M. van Kleef1 , J. Patijn1 . Management and Research Center, University Hospital Maastricht, Maastricht, 2 Rehabilitation Foundation Limburg, Hoensbroek, 3 Department of Medical, Clinical and Experimental Psychology, University of Maastricht, Maastricht, 4 Department of Anesthesiology, VU University medical center, Amsterdam, The Netherlands
Background: Several studies have shown that acupuncture point stimulation is an effective treatment for nausea and vomiting in pregnancy, the postoperative period, cancer and chemotherapy-induced nausea and vomiting. The acupuncture point P6 can be activated by acupuncture, TENS (transcutaneous electrical nerve stimulation) and other methods. A recent review has questioned the effect of non-invasive electrostimualtion when state-of-the-art pharmacologic antiemetic therapy is provided. Method: A case report of a patient resistant to pharmacologic treatment of nausea and vomiting is presented. Results: The case of a 79-year old female patient who had breast cancer on the right side with metastases to the spine and head is presented. Her major complaint was nausea and vomiting that could not be treated by state-of-the-art pharmacological antiemetic therapy. On admission to our palliative care unit she scored 9/10 for nausea on the ESAS-scale. After starting cyclizine 50 mg 3 times daily and additional TENSstimulation of the acupuncture point P6 with 2 Hertz for 30 minutes twice a day the nausea vanished (0/10). On one occasion the patient failed to place the electrode correctly over the point P6. On that day she complained again about nausea (4/10). After instruction of the patient and proper acupuncture point location nausea symptoms vanished after 20 minutes with TENS-stimulation on P6. Conclusion: This case reports shows that TENS has a place in the treatment of nausea and vomiting in palliative care. It showed to be effective in a patient who could not be treated effectively by pharmacological antiemetic therapy alone.
839 EFFICIENCY OF TENS TREATMENTS IN HEMIPLEGIC SHOULDER PAIN: A PLACEBO CONTROLLED STUDY A. Ekim ° , O. Armagan, C. Oner. Department of Physical Therapy and Rehabilitation, Osmangazi University Faculty of Medicine, Eskisehir, Turkey Objective: The aim of the present study was to evaluate the efficacy transcutaneous electrical nerve stimulation (TENS) treatment on shoulder pain in hemiplegic patients. Material and Methods: We studied a total of 19 hemiplegic patients with painful shoulder. The patients were randomly assigned into Group 1 (n = 10, TENS) and Group 2 (n = 9, placebo TENS). In Group 1, patients were given high-intensity TENS for 10 sessions. In Group 2, placebo TENS was given for the same period. All patients received conventional rehabilitation based on the Brunnstrom concept. Clinical assessments were performed at baseline, at the end of the treatment in all patients. The shoulder passive range of motion (PROM), and the visual analog scale (VAS), the Modified Rankin Scale and Functional Independence Measure, and Ashworth scale were performed to evaluate the Clinical and neurophysiological parameters. Results: Clinical and neurophysiological parameters were similar at baseline in both groups. In both groups significant improvements were observed in VAS after treatment (p < 0.001, p < 0.05 respectively). PROM for abduction and external rotation significant improvements were observed in hemiplegic shoulder in only group 1 after treatment (p < 0.001, p < 0.001 respectively). A comparison between the groups showed significant improvements in only VAS and PROMs in favor of group 1 after therapy (p < 0.05, p < 0.05 respectively). Conclusions: Our study results indicated that TENS seem to be effective in pain and shoulder PROMs in hemiplegic patients. We, therefore, suggest that TENS could be used as a good alternative therapy method on shoulder pain in hemiplegic patients.
1 Pain
Background and Aim: Studies on the effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) mainly focus on pain reduction as primary outcome. Reports of secondary effects of TENS such as; reduction of medication intake, increase in level of activity, and improved work capacity, are sparse. Long-term use of TENS might not solely due to pain reduction. The aim of our study is to investigate effectiveness of TENS beyond the domain of pain reduction. Method: In a prospective cohort the effectiveness of TENS in chronic pain was evaluated. After 6 months two subgroups were distinguished: ‘users’ (patients continuing TENS) and ‘nonusers’ (patients stopped using TENS). Besides pain reduction (Visual Analogue Scale; VAS), we evaluated: physical functioning (Short Form-36), work status, health care utilization, self-efficacy beliefs (Chronic Pain Self Efficacy Questionnaire; CPSEQ) and pain coping (Pain Coping and Cognition List; PCCL). Results: Of the 180 patients included, 149 returned for follow-up measurements at 6 months. 75 patients were in the users-group compared to 74 in nonusers-group. The users-group had statistically significant better improvements compared to nonusers-group: • pain reduction (VAS): 28% vs 0% • higher physical functioning (SF-36): 33% vs 11% • less health care utilization: – stop pain medication: 44% vs 25% – non current treatment: 50% vs 22% • higher self efficacy beliefs (CPSEQ: 22% vs 3%) • less catasthrophizing (PCCL): 11% vs 2% Conclusion: Besides pain reduction TENS is effective in increasing physical functioning, self-efficacy beliefs and decreasing health care utilization and catasthrophizing thoughts.
841 REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION AND PAIN RELIEF: THETA BURST STIMULATION A. Oliviero ° , M. Rubio-Esteban, A. Vari, J. De Andres, J.L. Diaz, J.M. Gomez-Arguelles, F. Sebastian de la Cruz, Y. Perez-Borrego. Hospital Nacional de Paraplejicos, Toledo, Spain The present study investigated whether five consecutive days of rTMS would lead to lasting pain relief in chronic intractable neuropathic pain. Eighteen patients with therapy resistant chronic pain syndromes participated. They received 40 seconds real rTMS over the hand area of motor cortex bilaterally (cTBS, 2×20 s trains, intensity 80% of motor threshold) every day for five consecutive days. Patients received, in a different session of 5 days, sham stimulation. Pain was assessed using a visual analogue scale (VAS). Real and sham rTMS had different effects on the VAS. RealrTMS led to a greater improvement in scales than sham-rTMS, evident even two weeks after the end of the treatment. No patient experienced severe adverse effects. These results confirm that five daily sessions of rTMS over motor cortex can produce longlasting pain relief in patients with neuropathic pain.