Fixed-Site High-Frequency Transcutaneous Electrical Nerve Stimulation Decreases Both Chronic Pain and Periodic Leg Movements--Evidence for Decreased Central Excitation and Enhanced Central Inhibition?
Periodic leg movements (PLMs) are repetitive movements occurring every five to 90 seconds. PLMs are associated with restless leg syndrome (RLS) and are elevated in chronic pain. Although the neurologic generator for PLMs is unknown, evidence points to increased central nervous system (CNS) excitabil...
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| Veröffentlicht in: | Pain medicine (Malden, Mass.) Mass.), 2019-03, Vol.20 (3), p.649 |
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| description | Periodic leg movements (PLMs) are repetitive movements occurring every five to 90 seconds. PLMs are associated with restless leg syndrome (RLS) and are elevated in chronic pain. Although the neurologic generator for PLMs is unknown, evidence points to increased central nervous system (CNS) excitability. Consistent with this mechanism, prescription opioids are used to treat RLS. Fixed-site high-frequency trans-cutaneous electrical nerve stimulation (FS-TENS) is an emerging form of TENS in which the stimulator is designed for a predetermined location rather than co-localization with the patient's pain. FS-TENS is believed to relieve chronic pain by decreasing central sensitization and enhancing descending inhibition through opioidergic pathways. We evaluated a real-world database of FS-TENS device use for chronic pain. The device and companion smartphone app collect dosage, demographics, pain characteristics, and sleep data (actigraphy). Responders had a [greater than or equal to]15% reduction in composite pain from baseline to 10 weeks (average pain intensity and interference with sleep, activity, mood; 11-point NRS). Participants with RLS or baseline PLM/h |
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PLMs are associated with restless leg syndrome (RLS) and are elevated in chronic pain. Although the neurologic generator for PLMs is unknown, evidence points to increased central nervous system (CNS) excitability. Consistent with this mechanism, prescription opioids are used to treat RLS. Fixed-site high-frequency trans-cutaneous electrical nerve stimulation (FS-TENS) is an emerging form of TENS in which the stimulator is designed for a predetermined location rather than co-localization with the patient's pain. FS-TENS is believed to relieve chronic pain by decreasing central sensitization and enhancing descending inhibition through opioidergic pathways. We evaluated a real-world database of FS-TENS device use for chronic pain. The device and companion smartphone app collect dosage, demographics, pain characteristics, and sleep data (actigraphy). Responders had a [greater than or equal to]15% reduction in composite pain from baseline to 10 weeks (average pain intensity and interference with sleep, activity, mood; 11-point NRS). Participants with RLS or baseline PLM/h <3 were excluded. Groups were compared by Wilcoxan rank-sum test. There were 98 responders and 111 nonresponders. Baseline PLM/h was different between the groups at baseline (responders 13.4 [+ or -] 13.4, nonresponders 9.1 [+ or -] 8.0, P = 0.007). There were no other clinically meaningful differences, including sleep measures. At follow-up, responders exhibited a 17% (interquartile range [IQR] = -42 to 13) decrease in PLM/h, compared with a 4% (IQR = -32 to 43) decrease for nonresponders (P = 0.04). We hypothesize that FS-TENS is most effective in individuals with enhanced CNS excitability, as indicated by elevated PLMs. We also hypothesize that FS-TENS reduces both pain and PLMs through an overlapping reduction in central excitation and/or enhancement of central inhibition. References: 1) Gozani SN. Effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation in chronic pain: A large-scale, observational study. J Pain Res 2018;11:703-14. 2) Sluka KA, Bjordal JM, Marchand S, Rakel BA. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature. 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PLMs are associated with restless leg syndrome (RLS) and are elevated in chronic pain. Although the neurologic generator for PLMs is unknown, evidence points to increased central nervous system (CNS) excitability. Consistent with this mechanism, prescription opioids are used to treat RLS. Fixed-site high-frequency trans-cutaneous electrical nerve stimulation (FS-TENS) is an emerging form of TENS in which the stimulator is designed for a predetermined location rather than co-localization with the patient's pain. FS-TENS is believed to relieve chronic pain by decreasing central sensitization and enhancing descending inhibition through opioidergic pathways. We evaluated a real-world database of FS-TENS device use for chronic pain. The device and companion smartphone app collect dosage, demographics, pain characteristics, and sleep data (actigraphy). Responders had a [greater than or equal to]15% reduction in composite pain from baseline to 10 weeks (average pain intensity and interference with sleep, activity, mood; 11-point NRS). Participants with RLS or baseline PLM/h <3 were excluded. Groups were compared by Wilcoxan rank-sum test. There were 98 responders and 111 nonresponders. Baseline PLM/h was different between the groups at baseline (responders 13.4 [+ or -] 13.4, nonresponders 9.1 [+ or -] 8.0, P = 0.007). There were no other clinically meaningful differences, including sleep measures. At follow-up, responders exhibited a 17% (interquartile range [IQR] = -42 to 13) decrease in PLM/h, compared with a 4% (IQR = -32 to 43) decrease for nonresponders (P = 0.04). We hypothesize that FS-TENS is most effective in individuals with enhanced CNS excitability, as indicated by elevated PLMs. We also hypothesize that FS-TENS reduces both pain and PLMs through an overlapping reduction in central excitation and/or enhancement of central inhibition. References: 1) Gozani SN. Effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation in chronic pain: A large-scale, observational study. J Pain Res 2018;11:703-14. 2) Sluka KA, Bjordal JM, Marchand S, Rakel BA. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature. Phys Ther 2013;93(10):1397-402.</description><subject>Care and treatment</subject><subject>Chronic pain</subject><subject>Methods</subject><subject>Neurologic manifestations of general diseases</subject><subject>Transcutaneous electrical nerve stimulation</subject><issn>1526-2375</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNptjs1OwzAQhHMAifLzDpY4GzWJ83dCJaS0UoFK7b1y7HWyKLGFnVTlDXksXBUBB7SHlWZmv9mzYBImUUqjOEsugkvn3qbTMGV5PAk-53gASTc4AFlg09K5hfcRtPggW8u1E-PANZjRkaoDMVgUvCMvYPdANgP2Y8cHNJo8grDAHTjyYIaWlK01GgVZc9SEa0nWYNFIr6ygIc9mDz3owVFa7VH6MiDK2B-IJKV3rS-qDgKHU8ORUumW-_Cvv9Qt1nj076-Dc8U7Bzff-yrYzqttuaCr16dlOVvRJs1iyiRLlJJhpEKVR1mdFDnLWBFBnE1TXkiIZcqKVCrJIK_rBEQeZiwqZFrkUShZfBXcnrAN72CHWhn_iOjRid0s9bQwisPYp-7-SfmR0KMwGhR6_c_BFw6QhQA</recordid><startdate>20190301</startdate><enddate>20190301</enddate><creator>Gozani, Shai</creator><creator>Ferree, Thomas C</creator><general>Oxford University Press</general><scope/></search><sort><creationdate>20190301</creationdate><title>Fixed-Site High-Frequency Transcutaneous Electrical Nerve Stimulation Decreases Both Chronic Pain and Periodic Leg Movements--Evidence for Decreased Central Excitation and Enhanced Central Inhibition?</title><author>Gozani, Shai ; Ferree, Thomas C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-g673-4d45ffd12f1f827b59847492e3706a9de3d6496dfd4e8bb5ec817429d69821d43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Care and treatment</topic><topic>Chronic pain</topic><topic>Methods</topic><topic>Neurologic manifestations of general diseases</topic><topic>Transcutaneous electrical nerve stimulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gozani, Shai</creatorcontrib><creatorcontrib>Ferree, Thomas C</creatorcontrib><jtitle>Pain medicine (Malden, Mass.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gozani, Shai</au><au>Ferree, Thomas C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Fixed-Site High-Frequency Transcutaneous Electrical Nerve Stimulation Decreases Both Chronic Pain and Periodic Leg Movements--Evidence for Decreased Central Excitation and Enhanced Central Inhibition?</atitle><jtitle>Pain medicine (Malden, Mass.)</jtitle><date>2019-03-01</date><risdate>2019</risdate><volume>20</volume><issue>3</issue><spage>649</spage><pages>649-</pages><issn>1526-2375</issn><abstract>Periodic leg movements (PLMs) are repetitive movements occurring every five to 90 seconds. PLMs are associated with restless leg syndrome (RLS) and are elevated in chronic pain. Although the neurologic generator for PLMs is unknown, evidence points to increased central nervous system (CNS) excitability. Consistent with this mechanism, prescription opioids are used to treat RLS. Fixed-site high-frequency trans-cutaneous electrical nerve stimulation (FS-TENS) is an emerging form of TENS in which the stimulator is designed for a predetermined location rather than co-localization with the patient's pain. FS-TENS is believed to relieve chronic pain by decreasing central sensitization and enhancing descending inhibition through opioidergic pathways. We evaluated a real-world database of FS-TENS device use for chronic pain. The device and companion smartphone app collect dosage, demographics, pain characteristics, and sleep data (actigraphy). Responders had a [greater than or equal to]15% reduction in composite pain from baseline to 10 weeks (average pain intensity and interference with sleep, activity, mood; 11-point NRS). Participants with RLS or baseline PLM/h <3 were excluded. Groups were compared by Wilcoxan rank-sum test. There were 98 responders and 111 nonresponders. Baseline PLM/h was different between the groups at baseline (responders 13.4 [+ or -] 13.4, nonresponders 9.1 [+ or -] 8.0, P = 0.007). There were no other clinically meaningful differences, including sleep measures. At follow-up, responders exhibited a 17% (interquartile range [IQR] = -42 to 13) decrease in PLM/h, compared with a 4% (IQR = -32 to 43) decrease for nonresponders (P = 0.04). We hypothesize that FS-TENS is most effective in individuals with enhanced CNS excitability, as indicated by elevated PLMs. We also hypothesize that FS-TENS reduces both pain and PLMs through an overlapping reduction in central excitation and/or enhancement of central inhibition. References: 1) Gozani SN. Effectiveness of fixed-site high-frequency transcutaneous electrical nerve stimulation in chronic pain: A large-scale, observational study. J Pain Res 2018;11:703-14. 2) Sluka KA, Bjordal JM, Marchand S, Rakel BA. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature. Phys Ther 2013;93(10):1397-402.</abstract><pub>Oxford University Press</pub></addata></record> |
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| ispartof | Pain medicine (Malden, Mass.), 2019-03, Vol.20 (3), p.649 |
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| language | eng |
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| source | Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Care and treatment Chronic pain Methods Neurologic manifestations of general diseases Transcutaneous electrical nerve stimulation |
| title | Fixed-Site High-Frequency Transcutaneous Electrical Nerve Stimulation Decreases Both Chronic Pain and Periodic Leg Movements--Evidence for Decreased Central Excitation and Enhanced Central Inhibition? |
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