The effect of two different types of electric current on experimental pain threshold in healthy individuals: A double blind, randomized controlled trial

Ayşe Numanoğlu Akbaş; Sinem Suner-keklik; Hatice Yakut; Ömer Osman Pala

doi:10.7197/cmj.vi.676491

Research Article

The effect of two different types of electric current on experimental pain threshold in healthy individuals: A double blind, randomized controlled trial

Year 2020, Volume: 42 Issue: 1, 19 - 27, 20.05.2020

Ayşe Numanoğlu Akbaş Sinem Suner-keklik Hatice Yakut Ömer Osman Pala

https://doi.org/10.7197/cmj.vi.676491

Abstract

Objective: Physiotherapists often resort to electrophysical agents for pain management.

The aim of this study is to determine the effect of acupuncture-like Transcutaneous Electrical Nerve Stimulation (TENS) and Neuromuscular Electrical Stimulation (NMES) on experimental pressure pain threshold (PPT) in healthy individuals.

Method: Sixty one healthy participants (44 females, 17 males) aged 18-21 years were included in the study.The participants were divided into acupuncture-like TENS and NMES groups. The application was performed for 20 minutes from the right upper limb. The PPT changes of the participants were evaluated from the thenar part of both hands with an algometer before the current application, immediately after and 60 minutes after.

Results: There was no difference in the PPT levels of the right and left extremities of the participants in both groups before the application (p>0.05). In both groups and intergroup comparisons, there was no difference in PPT levels measured from the right and left extremities of participants before the current application, immediately after and 60 minutes after the current application (p>0.05).

Conclusions: In this study, it was concluded that acupuncture-like TENS and NMES had no effect on experimental PPT and therefore, the clinical use of currents should be questioned.

Keywords

Electric stimulation therapy, pain, physical therapists, pressure

Supporting Institution

Scientific Research Project Fund of Sivas Cumhuriyet University

Project Number

SBF-66

References

1. Mittrach R, Grill E, Walchner-Bonjean M, Scheuringer M, Boldt C, Huber EO, Stucki, G. Goals of physiotherapy interventions can be described using the International Classification of Functioning, Disability and Health. Physiother. 2008;94:150-7.
2. Ginnerup-Nielsen E, Christensen R, Thorborg K, Tarp S, Henriksen M. Physiotherapy for pain: a meta-epidemiological study of randomised trials. Br J Sports Med. 2016;50:965-71.
3. Fırat T, Meriç A, Kırdı N. Magnetoterapi ve ultrason uygulamalarının deneysel ağrı üzerine etkilerinin karşılaştırılması: tek kör klinik çalışma. Türk Fizyoterapi ve Rehabilitasyon Dergisi. 2009;20:178-83.
4. Springer S, Laufer Y, Elboim-Gabyzon M. Clinical decision making for using electro-physical agents by physiotherapists, an Israeli survey. Israel journal of health policy research. 2015;4:14.
5. Johnson MI. Pain Management and Clinical Effectiweness of TENS. Crit Rev Phys Rehabil Med. 2017;29:1-4
6. McDenough S. Neuromuscular and Muscular Electrical Stimulation. Watson T. (Eds.) Electrotherapy E-Book: evidence-based practice. 12th Ed. Philedelphia: Elsevier Health Sciences; 2008; pp 231-252
7. Kırdı N. Nöromusküler Elektrik Stimulasyonu. Şimşek N, Kırdı N. (Eds.) Elektroterapide Temel Prensipler ve Klinik Uygulamalar. 1st Ed. Ankara: Pelikan Yayıncılık; 2015; pp 119-126.
8. Baydoğan Arman N. Nöromusküler Elektriksel Stimulasyon. Razak Özdinçler A. (Eds.) Fiziksel Modaliteler ve Elektroterapi. 1st ed. İstanbul: İstanbul Medikal Sağlık ve Yayıncılık Hiz. Tic. Ltd. Şti; 2014; pp 139-148.
9. Walsh DM, McAdams ET.(Eds.) TENS: clinical applications and related theory: New York : Churchill Livingstone, 1997.
10. Grimmer K. A controlled double blind study comparing the effects of strong burst mode TENS and high rate TENS on painful osteoarthritic knees. Aust J Physiother. 1992;38:49-56.
11. Jensen H, Zesler R, Christensen T. Transcutaneous electrical nerve stimulation (TENS) for painful osteoarthrosis of the knee. Int J Rehabil Res. 1991;14:356-8.
12. Tulgar M, McGlone F, Bowsher D, Miles JB. Comparative effectiveness of different stimulation modes in relieving pain. Part II. A double-blind controlled long-term clinical trial. Pain. 1991;47:157-62.
13. Tulgar M, McGlone F, Bowsher D, Miles JB. Comparative effectiveness of different stimulation modes in relieving pain. Part I. A pilot study. Pain. 1991;47:151-5.
14. Köke AJ, Schouten JS, Lamerichs-Geelen MJ, Lipsch JS, Waltje EM, van Kleef M, et al. Pain reducing effect of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: a randomized crossover trial. Pain. 2004;108:36-42.
15. Chesterton LS, Barlas P, Foster NE, Lundeberg T, Wright CC, Baxter GD. Sensory stimulation (TENS): effects of parameter manipulation on mechanical pain thresholds in healthy human subjects. Pain. 2002;99:253-62.
16. BOYACI A. Nöromusküler Elektriksel Stimülasyon. Turkiye Klinikleri Journal of Physical Medicine Rehabilitation Special Topics. 2015;8:44-50.
17. Renzenbrink GJ, Ijzerman MJ. Percutaneous neuromuscular electrical stimulation (P-NMES) for treating shoulder pain in chronic hemiplegia. Effects on shoulder pain and quality of life. Clin. rehabil. 2004;18:359-65.
18. Gaines JM, Metter EJ, Talbot LA. The effect of neuromuscular electrical stimulation on arthritis knee pain in older adults with osteoarthritis of the knee. Appl Nurs Res. 2004;17:201-6.
19. Chen CC, Johnson MI. An Investigation Into the Effects of Frequency-Modulated Transcutaneous Electrical Nerve Stimulation (TENS) on Experimentally-Induced Pressure Pain in Healthy Human Participants. Journal of Pain. 2009;10:1029-37.
20. Claydon LS, Chesterton LS, Barlas P, Sim J. Dose-specific effects of transcutaneous electrical nerve stimulation (TENS) on experimental pain: a systematic review. Clin J Pain. 2011;27:635-47.
21. Macedo LB, Josue AM, Maia PH, Camara AE, Brasileiro JS. Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial. Physiotherapy. 2015;101:155-60.
22. Ring IJ, Markström A, Bazargani F, Nevéus T. Sleep disordered breathing in enuretic children and controls. J Pediatr Urol. 2017;13: e1-. e6.
23. Kinser AM, Sands WA, Stone MH. Reliability and validity of a pressure algometer. J Strength Cond Res. 2009;23:312-4.
24. Chesterton LS, Sim J, Wright CC, Foster NE. Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters. Clin J Pain 2007;23:760-6.
25. Willer J, Bouhassira D, Le DBJNcCn. Neurophysiological bases of the counterirritation phenomenon: diffuse control inhibitors induced by nociceptive stimulation. Clin Neurophysiol. 1999;29:379-400.
26. Marchand S. The phenomenon of pain: Lippincott Williams & Wilkins; 2015.
27. Sluka KA, Lisi TL, Westlund KN . Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electric nerve stimulation in rats with joint inflammation. Arch Phys Med Rehabil. 2006;87:1137-40.
28. Chen C-C, Johnson MI. An investigation into the hypoalgesic effects of high-and low-frequency transcutaneous electrical nerve stimulation (TENS) on experimentally-induced blunt pressure pain in healthy human participants. J Pain. 2010;11:53-61.
29. Solomon J, Shebshacvich V, Adler R, Vulfsons S, Rosenbach A, Eisenberg E. The effects of TENS, heat, and cold on the pain thresholds induced by mechanical pressure in healthy volunteers. Neuromodulation. 2003;6:102-7.
30. Manal TJ, Snayder-Mackler L. Electrical Stimulation for Pain Modulation. Robinson AJ. (Eds.) Clinical electrophysiology: electrotherapy and electrophysiologic testing. 3 rd ed. Philedelphia; Lippincott Williams & Wilkins; 2008; pp 151-196.
31. Chen C-C, Tabasam G, Johnson MI. Does the pulse frequency of transcutaneous electrical nerve stimulation (TENS) influence hypoalgesia?: A systematic review of studies using experimental pain and healthy human participants. Physiother. 2008;94:11-20.
32. de Tommaso M, Fiore P, Camporeale A, Guido M, Libro G, Losito L,Megna M, Puca F, Megna G. High and low frequency transcutaneous electrical nerve stimulation inhibits nociceptive responses induced by CO2 laser stimulation in humans. Neurosci Lett. 2003;342:17-20.
33. Chakour M-C, Gibson S, Neufeld M, Khalil Z, Helme RD. Development of an active placebo for studies of TENS treatment. Proceedings of the 9th World Congress on Pain. 2000;16:987-92.
34. Walsh DM, Liggett C, Baxter D, Allen JMJP. A double-blind investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon experimentally induced ischaemic pain. Pain Res. 1995;61:39-45.
35. Bergeron-Vézina K, Corriveau H, Martel M, Harvey M-P, Léonard G. High-and low-frequency transcutaneous electrical nerve stimulation does not reduce experimental pain in elderly individuals. Pain. 2015;156:2093-9
36. Tanaka K, Ikeuchi M, Izumi M, Aso K, Sugimura N, Enoki H, Nagano Y, Ishida K, Tani T. Effects of two different intensities of transcutaneous electrical nerve stimulation on pain thresholds of contralateral muscles in healthy subjects. J Phys Ther Sci.2015;27:2771-4.
37. Moran F, Leonard T, Hawthorne S, Hughes CM, McCrum-Gardner E, Johnson MI, Rakel BA, Sluka KA, Walsh DM. Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. J Pain. 2011;12:929-35.
38. Claydon L, Chesterton L. Does transcutaneous electrical nerve stimulation (TENS) produce'dose-responses'? A review of systematic reviews on chronic pain. Phys Ther Rev. 2008;13:450-63.
39. Johnson M, Ashton C, Thompson J. The consistency of pulse frequencies and pulse patterns of transcutaneous electrical nerve stimulation (TENS) used by chronic pain patients.Pain. 1991;44:231-4.
40. Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database Syst Rev. 2008(3).
41. Sluka K, Vance C, Lisi T. High‐frequency, but not low‐frequency, transcutaneous electrical nerve stimulation reduces aspartate and glutamate release in the spinal cord dorsal horn. J. Neurochem.2005;95:1794-801.
42. Kulcu DG, Yanik B, Gulsen G, Gokmen D. Effect of Neuromuscular Electrical Stimulation on Pain and Functional Parameters in Knee Osteoarthritis. Turkish Journal of Physical Medicine and Rehabilitation. 2009;55:111-5.
43. Naaman SC, Stein RB, Thomas C. Minimizing discomfort with surface neuromuscular stimulation. Neurorehabil Neural Repair. 2000;14:223-8.
44. Laufer Y, Tausher H, Esh R, Ward AR. Sensory transcutaneous electrical stimulation fails to decrease discomfort associated with neuromuscular electrical stimulation in healthy individuals. Am J PHYS Med Rehabil. 2011;90:399-406.