Dokument: High-tone external muscle stimulation (HTEMS) for radicular leg pain compared to transcutaneous electrical nerve stimulation (TENS)
| Titel: | High-tone external muscle stimulation (HTEMS) for radicular leg pain compared to transcutaneous electrical nerve stimulation (TENS) | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=41294 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20170301-113045-4 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Englisch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Darwish Mohamed, Eslam [Autor] | |||||||
| Dateien: |
| |||||||
| Beitragende: | Prof. Dr. Jander, Sebastian [Gutachter] Prof. Krüger, Martina [Gutachter] | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | ABSTRACT
Sciatica is a common pain problem that affects not only the patient but also constitutes a socioeconomic burden and thus concerns the whole society. So far, current pharmacologic therapies are inadequate for many patients. Only few non drug-based therapies have proven a positive impact. We evaluated application of high-tone electrical muscle stimulation (HTEMS) compared to transcutaneous electrical nerve stimulation (TENS) on radicular pain associated with sciatica. Hospital patients (n = 100) with chronic sciatica and stable oral analgesic regimen were included into this randomized controlled cross-over trial. Each intervention was administered for a period of 45 min 5 times within 10 days, with a 3-day wash-out period before cross-over. Pain impairment was assessed using the visual analog scales (VAS) for radicular pain before and after intervention. Differences in radicular pain between groups were analysed with the Mann-Whitney test. During the 1st phase of intervention radicular pain intensity was significantly reduced during HTEMS treatment (p<0.0001), while no statistically significant improvement occurred with TENS. Pain reduction was reported by 56% of the participants after HTEMS and by 41% using TENS (Odds Ratio 1.83[1.05−3.21]). After cross-over, significant pain reduction was observed for both groups (p < 0.0001 with HTEMS and p = 0.0015 with TENS). While carry-over effects could be excluded, the difference of radicular pain reduction demonstrated a higher pain improving potential for HTEMS than for TENS (p=0.011). Conclusions HTEMS bares a higher potential for short term reduction of radicular pain than TENS and might offer new therapeutic strategies for treatment of chronic sciatica. Keywords high-tone external muscle stimulation (HTEMS), transcutaneous electrical nerve stimulation (TENS), chronic sciatica, Cauda equina syndrome (CES), Chronic pain syndrome (CPS)ABSTRACT Sciatica is a common pain problem that affects not only the patient but also constitutes a socioeconomic burden and thus concerns the whole society. So far, current pharmacologic therapies are inadequate for many patients. Only few non drug-based therapies have proven a positive impact. We evaluated application of high-tone electrical muscle stimulation (HTEMS) compared to transcutaneous electrical nerve stimulation (TENS) on radicular pain associated with sciatica. Hospital patients (n = 100) with chronic sciatica and stable oral analgesic regimen were included into this randomized controlled cross-over trial. Each intervention was administered for a period of 45 min 5 times within 10 days, with a 3-day wash-out period before cross-over. Pain impairment was assessed using the visual analog scales (VAS) for radicular pain before and after intervention. Differences in radicular pain between groups were analysed with the Mann-Whitney test. During the 1st phase of intervention radicular pain intensity was significantly reduced during HTEMS treatment (p<0.0001), while no statistically significant improvement occurred with TENS. Pain reduction was reported by 56% of the participants after HTEMS and by 41% using TENS (Odds Ratio 1.83[1.05−3.21]). After cross-over, significant pain reduction was observed for both groups (p < 0.0001 with HTEMS and p = 0.0015 with TENS). While carry-over effects could be excluded, the difference of radicular pain reduction demonstrated a higher pain improving potential for HTEMS than for TENS (p=0.011). Conclusions HTEMS bares a higher potential for short term reduction of radicular pain than TENS and might offer new therapeutic strategies for treatment of chronic sciatica. Keywords high-tone external muscle stimulation (HTEMS), transcutaneous electrical nerve stimulation (TENS), chronic sciatica, Cauda equina syndrome (CES), Chronic pain syndrome (CPS) | |||||||
| Quelle: | References:
(1) Laslett M1, Moses A. N Z Med J. 1991 Oct 9;104(921):424-6. The frequency and incidence of low back pain/sciatica in an urban population. (2) Roger et al., Oregon Health & Science University, Portland, Oregon Am Fam Physician. 2011 Aug 15;84(4):437-438. Low Back Pain (Chronic) (3) Federico Balagué et al. Non-specific low back pain. 2012 February 4; 379(9814): 482–491. Published online 2011 October 6. doi: 10.1016/S0140-6736(11)60610-7 (4) Pai, Seema et al. "Low back pain: an economic assessment in the United States." Orthopedic Clinics of North America 35.1 (2004): 1-5. (5) Atlas SJ et al. Evaluating and Managing Acute Low Back Pain in the Primary Care Setting. Journal of General Internal Medicine. 2001;16(2):120-131. doi:10.1111/j.1525-1497.2001.91141.x. (6) J. Valat, S. Genevay, M. Marty, S. Rozenberg, and B. Koes, “Sciatica,” in Best practice& research. Clinical rheumatology 24 (2): 241–52, 2009. (7) Stein et al. “Guideline on non-operative and rehabilitative treatment of disc degeneration with radicular symptoms,” in OUP 2014. (8) Kenneth M. C. Cheung et al. `Prevalence and Pattern of Lumbar Magnetic Resonance Imaging Changes in a Population Study of One Thousand Forty-Three Individuals; spine Volume 34, Number 9, pp 934 –940, 2009 (9) Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14; 331(2): 69-73. (10) Farfan HF (1980) The pathological anatomy of degenerative spondylolisthesis: A cadaver study. Spine 5:412-418 (11) Deftereos SN, et al. (April–June 2009). "Localisation of cervical spinal cord compression by TMS and MRI". Funct Neurol 24 (2): 99–105. PMID 19775538. (12) Ghoname et al. “Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study,”in JAMA, 1999. (13) van Tulder MW (2004) Quality of primary care guidelines for acute low back pain. Spine, 29(17): E357-62. (14) Heidland et al. “historical aspects and current possibilities in treatment of pain and muscle waisting.,” in Neuromuscular electrostimulation techniques, 2013. (15) Johnson et al “The analgesic effects and clinical use of acupuncture – like tens (al – tens),” in Phys Ther Rev., 1998. (16) Buttermann et al., “Treatment of lumbar disc herniation: epidural steroid injection compared with discectomy.,” in A prospective, randomized study. J Bone Joint Surg Am, 1997. (17) Gildenberg et al., “History of electrical neuromodulation of chronic pain,” in Pain Medicine, 2006. (18) DeSanta et al., “Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain,” in Curr Rheumatol Rep., 2008. (19) DeSanta et al., “Transcutaneous electrical nerve stimulation at both high and low frequencies activates ventrolateral periaqueductal grey to decrease mechanical hyperalgesia in arthritic rats.,” in Neuroscience, 2009. (20) Garrison et al. “Decreased activity of spontaneous and noxiously evoked dorsal horn cells during transcutaneous electrical nerve stimulation (tens),” in Pain, 1994. (21) Karla et al. “Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (tens),” in J Pharmacol Exp Ther., 2001. (22) Sabino et al., “Release of endogenous opioids following transcutaneous electric nerve stimulation in an experimental model of acute inflammatory pain,” in J Pain., 2008. (23) Salar et al., “Effect of transcutaneous electrotherapy on csf betaendorphin content in patients without pain problems,” in Pain, 1981. (24) Hughes et al., “Response of plasma beta endorphins to transcutaneous electrical nerve stimulation in healthy subjects,” in Phys Ther., 1984. (25) Schmauss et al., “Pharmacological antagonism of the antinociceptive effects of serotonin in the rat spinal cord,” in Eur J Pharmacol., 1983. (26) Maeda et al., “Release of gaba and activation of gaba(a) in the spinal cord mediates the effects of tens in rats.,” in Brain Res., 2007. (27) Schechtman et al. , “Cholinergic mechanisms involved in the pain relieving effect of spinal cord stimulation in a model of neuropathy,” in Pain, 2008. (28) Sluka et al., “High-frequency, but not low-frequency, transcutaneous electrical nerve stimulation reduces aspartate and glutamate release in the spinal cord dorsal horn,” in J Neurochem., 2005. (29) Rokugo et al., “A histochemical study of substance p in the rat spinal cord: effect of transcutaneous electrical nerve stimulation,” in J Nihon Med Sch., 2002. (30) Tinazzi et al., “Long-lasting modulation of human motor cortex following prolonged transcutaneous electrical nerve stimulation (tens) of forearm muscles: evidence of reciprocal inhibition and facilitation,” in Exp Brain Res, 2005. (31) S. J, “Adenosine receptor activation and nociception,” in Eur J Pharmacol., 1998. (32) Chandran et al., “Development of opioid tolerance with repeated transcutaneous electrical nerve stimulation administration,” in Pain, 2003. (23) DeSanta et al., “Modulation between high- and low frequency transcutaneous electric nerve stimulation delays the development of analgesic tolerance in arthritic rats,” in Arch Phys Med Rehabil, 2008. (34) Wikström et al., “Effect of transcutaneous nerve stimulation on microcirculation in intact skin and blister wounds in healthy volunteers,”in Scand J Plast Reconstr Surg Hand Surg., 1999. (35) Malik et al. “Microangiopathy in human diabetic neuropathy: relationship between capillary abnormalities and the severity of neuropathy,” in Diabetologia, 1989. (36) Kaada et al., “Vasodilation induced by transcutaneous nerve stimulation in peripheral ischemia (raynaud’s phenomenon and diabetic polyneuropathy),” in Eur Heart J, 1982. (37) Kaada et al., “Transcutaneous nerve stimulation in patients with coronary arterial disease: haemodynamic and biochemical effects,” in Eur Heart J, 1990. (38) Croom et al., “Role of nitric oxide in cutaneous blood flow increases in the rat hindpaw during dorsal column stimulation,” in Neurosurgery, 1997. (39) Göskel et al., “Nitric oxide synthase inhibition attenuates vasoactive response to spinal cord stimulation in an experimental cerebral vasospasm model,” in Acta Neurochir (Wien), 2001. (40) Tanaka et al., “Role of primary afferents in spinal cord stimulation-induced vasodilation: characterization of fiber types,” in Brain Res, 2003. (41) Foreman et al., “Modulation of intrinsic cardiac neurons by spinal cord stimulation: implications for its therapeutic use in angina pectoris,” in Cardiovasc Res, 2000. (42) Reichstein et al., “Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation,” in Diabetologia, 2005. (43) Humpert et al., “External electric muscle stimulation improves burning sensations and sleeping disturbances in patients with type 2 diabetes and symptomatic neuropathy,” in Pain Med, 2009. (44) Reichstein et al., “Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation.,” in Diabetologia, 2005. (45) Thomas et al., “Efficacy of transforaminal versus interspinous corticosteroid injectionin discal radiculalgia.,” in A prospective, randomised, doubleblind study. Clin Rheumatol, 2003. (46) Klenerman et al., “Lumbar epidural injections in the treatment of sciatica.,” in Br J Rheumatol, 1984. (47) Carette et al., “Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus.,” in N Engl J Med, 1997. (48) O. H, S. S, K. J, and M. A, “Effectiveness of microdiscectomy for lumbar disc herniation: a randomized controlled trial with 2 years of follow-up.,” in Spine (Phila Pa 1976 ), 2006. (49) Osterman et al., “Surgery versus prolonged conservative treatment for sciatica.,” in N Engl J Med, 2007. | |||||||
| Rechtliche Vermerke: | Ich versichere an Eides statt, dass die Dissertation selbständig und ohne
unzulässige fremde Hilfe erstellt worden ist und die hier vorgelegte Dissertation nicht von einer anderen medizinischen Fakultät abgelehnt worden ist. | |||||||
| Lizenz: |  Urheberrechtsschutz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 01.03.2017 | |||||||
| Dateien geändert am: | 01.03.2017 | |||||||
| Promotionsantrag am: | 07.06.2016 | |||||||
| Datum der Promotion: | 21.02.2017 |
