بررسی انواع درد، روش‌های مهار آن و تأثیر TENS برروی درد
محورهای موضوعی : انرژی های تجدیدپذیر
فاطمه شیاسی
1
(دانشکده مهندسی برق- واحد نجف آباد، دانشگاه آزاد اسلامی، نجف آباد، ایران)
محمدرضا یوسفی
2
(مرکز تحقیقات ریز شبکه های هوشمند- واحد نجف آباد، دانشگاه آزاد اسلامی، نجف آباد، ایران)
کلید واژه: تحریک الکتریکی عصب از طریق پوست, تسکین درد, درد حاد و مزمن, کنترل درد,
چکیده مقاله :
درد یک پدیده مهم فیزیولوژیک است که از بدو تولد تا آخرین مراحل زندگی وجود دارد و یکی از عوامل مراجعه بیمار به درمانگاه‌ها و مراکز درمانی است. کنترل درد یکی از چالش‌های عمده متخصصین جراحی و بیهوشی است. عدم کنترل مناسب درد باعث طولانی شدن زمان بستری بیماران و تحمیل هزینه‌های درمانی بیشتر به بیماران و بیمارستان‌ها و نارضایتی از نحوه درمان پزشک و مراجعات مکرر به پزشکان مختلف جهت کنترل درد می‌شود. تنها راه تسکین درد استفاده از دارو نیست؛ بلکه راه‌های دیگر با توجه به علل ایجادکننده و نوع درد وجود دارند. یک روش غیرتهاجی برای تسکین درد تحریک الکتریکی اعصاب مهاری درد از طریق پوست(TENS) است. در حین استفاده از TENS، جریان‌های الکتریکی پالسی، در سطح پوست سالم توزیع می‌‌‌شوند تا حس قوی و غیردردناک TENS ایجاد شده یا کشش عضله را در محل درد ملایم می‌کند. روش درمانی TENS از انتقال اطلاعات مربوط به درد به بالا در سیستم عصبی مرکزی ممانعت کرده و به نظر می‌رسد که برای دردهای حاد و مزمن مفید است. در مطالعه حاضر، تأثیر استفاده از TENS برروی انواع درد مورد بررسی قرار گرفته و به نتایج مثبت تسکین درد عضلانی-اسکلتی و درد پس از عمل جراحی اشاره می‌کند، اگرچه بیشتر مطالعات سیستماتیک، بی‌نتیجه بودند.
Pain is an important physiological phenomenon that occurs from birth to the last stages of life. Pain is one of the causes of the patient's referral to clinics and treatment centers. Pain control is one of the major challenges for surgeons and anesthesiologists. Lack of proper pain control lead to hospitalization and imposes higher treatment costs for patients and hospitals. It causes dissatisfaction with the medical treatment and frequent visits to medicians to control the pain. Medication is not only way for pain reduction; depending on the cause and type of pain, other ways can employ. Electrical stimulation of nerve pain inhibitors through the skin (TENS) is a noninvasive technique to relieve pain. During TENS, pulsed electrical currents are administered across the intact surface of the skin to generate strong nonpainful TENS sensations or mild muscle twitching at the site of pain. This technique inhibits onward transmission of nociceptive (pain-related) information in the central nervous system and appears to be beneficial for acute and chronic pain. In the present study, the effect of TENS on different types of pain investigated and positive outcomes in musculoskeletal relief and post-operative pain suggested, although many systematic reviews were inconclusive.
[1] International Association for the Study of Pain 2010 Annual Report, IASP, 2010.
[2] M. Johnson, “Transcutaneous electrical nerve stimulation: Mechanisms, clinical application and evidence”, Reviews in Pain, vol. 1, no. 1, pp. 7–11, Aug. 2007 (doi: 10.1177/204946370700100103).
[3] K. Sunil Kumar Reddy , M.U.R. Naidu, P. Usha Rani, T. Ramesh Kumar Rao, “Human experimental pain models: A review of standardized methods in drug development”, Journal of Research Medical Sciences, vol. 17, no. 6, pp. 587–595, June 2012 (www.ncbi.nlm.nih.gov/pmc/articles/PMC3634303/).
[4] R. Memar, M. Farokhpur, A. Mesripur, “Medical Pharmacology (nursing-midwifery-anesthesiology)”, 3rd Edition. Andishe Rafie Pub., 2020 (in Persian).
[5] R. Bousso, K. Poles, D. Cruz “Nursing concepts and theories”, vol. 48, no. 1, pp. 141-145, Feb. 2014 (doi: 10.1590/S0080-623420140000100018).
[6] J.L. Hinkle, K.H. Cheever, “Brunner & Suddarth's textbook of medical-surgical nursing”, 14th Edition, LWW Pub., 2018.
[7] F. Elahi, “Chronic pain: nature-experience-tolerance”, 1st Ed., T. Teymurzadeh Pub., Iran: Tehran, 2001 (in Persian).
[8] Aghili Khorasani MH. Treatments (Moalejat Aghili). Tehran; Research Institute for Islamic and Complementary Medicine; 2009:579 (in Persian).
[9] R.P. Francis, M.I. Johnson, “The characteristics of acupuncture-like transcutaneous electrical nerve stimulation (acupuncture-like TENS): A literature review”, Acupuncture and Electro-Therapeutics Research, vol. 36, no (3-4), pp. 58-231, Jan. 2011 (doi: 10.3727/036012911803634139).
[10] M. Johnson, “Acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) in the management of pain”, Physical Therapy Reviews, vol. 3, pp. 73–93, 1998 (doi.org/10.1179/ptr.1998.3.2.73).
[11] L. Brown, M. Holmes, A. Jones, “The application of transcutaneous electrical nerve stimulation to acupuncture points (Acu-TENS) for pain relief: a discussion of efficacy and potential mechanisms”, Physical Therapy Reviews, vol. 14, no. 2, pp 93-103, April. 2009 (doi.org/10.1179/174328809X405964).
[12] A.W. Rutjes, E. Nuesch, R. Sterchi, L. Kalichman, E. Hendriks, M. Osiri, L. Brosseau, S. Reichenbach, P. Jüni, “Transcutaneous electrostimulation for osteoarthritis of the knee”, Cochrane Database of Systematic Reviews, vol. 7, no. 4, Oct. 2009 (doi.10.1002/14651858.CD002823.pub2).
[13] H. Burri, V. Piguet, “UninTENSional pacemaker interactions with transcutaneous electrical nerve stimulation”, Europace, vol. 11, no. 3, pp. 283–284, Mar. 2009 (doi: 10.1093/europace/eup008).
[14] Y. Coldron, E. Crothers, J. Haslam, W. Notcutt, T. Watson, R. Thomas, D. Sidney, “ACPWH guidance on the safe use of transcutaneous electrical nerve stimulation (TENS) for musculosketal pain during pregnancy”, 2007 (www.electrotherapy.org/downloads/Modalities/TENS in pregnancy guidelines.pdf).
[15] K.E. Nnoaham, J. Kumbang, “Transcutaneous electrical nerve stimulation (TENS) for chronic pain”, Cochrane Database of Systematic Reviews, vol. 16, no. 3, July 2008 (doi: 10.1002/14651858.CD003222.pub2).
[16] J.M. Bjordal, M.I. Johnson, R.A. Lopes-Martins, B. Bogen, R. Chow, A.E. Ljunggren, “Shortterm efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials”, BMC Musculoskeletal Disorders, vol. 8, no. 51, June 2007 (doi: 10.1186/1471-2474-8-51).
[17] G. Cruccu, T.Z. Aziz, L. Garcia-Larrea, P. Hansson, T.S. Jensen, J-P. Lefaucheur, B.A. Simpson, R.S. Taylor, “EFNS guidelines on neurostimulation therapy for neuropathic pain”, European Journal of Neurology, vol. 14, no. 9, pp. 952-970, Oct. 2007 (doi: 10.1111/j.1468-1331.2007.01916.x).
[18] C.I. Price, A.D. Pandyan, “Electrical stimulation for preventing and treating post-stroke shoulder pain: A systematic cochrane review”, Clinical Rehabilitation, vol. 15, no. 1, pp. 5–19, Feb. 2001 (doi: 10.1191/026921501670667822).
[19] S. Jena, C.M. Witt, B. Brinkhaus, K. Wegscheider, S.N. Willich, “Acupuncture in patients with headache”, Cephalalgia, vol. 28, no. 9, pp. 969–979, Sept. 2008 (doi.org/10.1111/j.1468-2982.2008.01640.x).
[20] A. Khadilkar, D.O. Odebiyi, L. Brosseau, G.A. Wells, “Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain”, Cochrane Database of Systematic Reviews, vol. 4, no. 4, Feb. 2008 (doi: 10.1002/14651858.CD003008.pub3).
[21] S. Poitras, L. Brosseau, “Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy”, Spine Journal, vol. 8, no. 1, pp. 226-233, Jan.–Feb. 2008 (doi: 10.1016/j.spinee.2007.10.022).
[22] L.A.C. Machado, S.J. Kamper, R.D. Herbert, C.G. Maher, J.H. McAuley, “Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials”, Rheumatology (Oxford), vol. 48, no. 5, pp. 520–527, Dec. 2008 (doi: 10.1093/rheumatology/ken470).
[23] M.I. Bennett, N. Hughes, M.I. Johnson, “Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: low fidelity may explain negative findings”, Pain, vol. 152, no. 6, pp. 1226–1232, June 2011 (doi: 10.1016/j.pain.2010.12.009. Epub 2011 Mar 23).
[24] S. Hasan, “Comparative Study: Analgesic effect of Al-TENS in variation of treatment time on experimentally induced ischaemic pain in healthy young adult”, Indian Journal of Physiotherapy and Occupational Therapy, Vol. 7, No. 2, pp. 255-260, Jan. 2013 (doi:10.5958/J.0973-5674.7.2.051).
[25] H.O. Handwerker, G. Kobal, “Psychophysiology of experimentally induced pain”, Physiological Reviews, Vol. 73, No. 3, pp. 639-671, July 1993 (doi: 10.1152/physrev.1993.73.3.639).
[26] P.A. Moore, G.H. Duncan, D.S. Scott, J.M. Gregg, J.N. Ghia, “The submaximal effort tourniquet test: its use in evaluating experimental and chronic pain”, Pain, Vol. 6, No. 3, pp. 375-382, May 1979 (doi: 10.1016/0304-3959(79)90055-1).
[27] J.T. Farrar, J.P. Young Jr, L. LaMoreaux, J.L. Werth, R.M. Poole, “Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale”, Pain, Vol. 94, No. 2, pp. 149-158, Nov. 2001 (doi: 10.1016/S0304-3959(01)00349-9).
[28] C.C. Chen, M.I. Johnson, “Differential frequency effects of strong nonpainful transcutaneous electrical nerve stimulation on experimentally induced ischemic pain in healthy human participants”, Clinical Journal of Pain, Vol. 27, No. 5, pp. 434-441, Mar. 2011 (doi: 10.1097/AJP.0b013e318208c926).
[29] M. Ebrahimian, M. Razeghi, A. Zamani, Z. Bagheri, K. Rastegar, A. Motealleh, “Does high frequency transcutaneous electrical nerve stimulation (TENS) affect EEG gamma band activity?”, Journal of Biomedical Physics and Engineering, Vol. 8, No. 1, pp. 271-280, Sept. 2018 (doi:10.31661/jbpe.v8i3sep.780).
[30] K.A. Sluka, C.G. Vance, T.L. Lisi, “High-frequency, but not low-frequency, transcutaneous electrical nerve stimulation reduces aspartate and glutamate release in the spinal cord dorsal horn”, Journal of Neurochemistry, Vol. 95, No. 6, pp. 1794-1801, Dec. 2005 (doi: 10.1111/j.14714159.2005.03511.x).
[31] G. Leonard, P. Goffaux, S. Marchand, “Deciphering the role of endogenous opioids in high-frequency TENS using low and high doses of naloxone”, Pain, Vol. 151, No. 1, pp. 215-219, Oct. 2010 (doi: 10.1016/j. pain.2010.07.012).
_||_[1] International Association for the Study of Pain 2010 Annual Report, IASP, 2010.
[2] M. Johnson, “Transcutaneous electrical nerve stimulation: Mechanisms, clinical application and evidence”, Reviews in Pain, vol. 1, no. 1, pp. 7–11, Aug. 2007 (doi: 10.1177/204946370700100103).
[3] K. Sunil Kumar Reddy , M.U.R. Naidu, P. Usha Rani, T. Ramesh Kumar Rao, “Human experimental pain models: A review of standardized methods in drug development”, Journal of Research Medical Sciences, vol. 17, no. 6, pp. 587–595, June 2012 (www.ncbi.nlm.nih.gov/pmc/articles/PMC3634303/).
[4] R. Memar, M. Farokhpur, A. Mesripur, “Medical Pharmacology (nursing-midwifery-anesthesiology)”, 3rd Edition. Andishe Rafie Pub., 2020 (in Persian).
[5] R. Bousso, K. Poles, D. Cruz “Nursing concepts and theories”, vol. 48, no. 1, pp. 141-145, Feb. 2014 (doi: 10.1590/S0080-623420140000100018).
[6] J.L. Hinkle, K.H. Cheever, “Brunner & Suddarth's textbook of medical-surgical nursing”, 14th Edition, LWW Pub., 2018.
[7] F. Elahi, “Chronic pain: nature-experience-tolerance”, 1st Ed., T. Teymurzadeh Pub., Iran: Tehran, 2001 (in Persian).
[8] Aghili Khorasani MH. Treatments (Moalejat Aghili). Tehran; Research Institute for Islamic and Complementary Medicine; 2009:579 (in Persian).
[9] R.P. Francis, M.I. Johnson, “The characteristics of acupuncture-like transcutaneous electrical nerve stimulation (acupuncture-like TENS): A literature review”, Acupuncture and Electro-Therapeutics Research, vol. 36, no (3-4), pp. 58-231, Jan. 2011 (doi: 10.3727/036012911803634139).
[10] M. Johnson, “Acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) in the management of pain”, Physical Therapy Reviews, vol. 3, pp. 73–93, 1998 (doi.org/10.1179/ptr.1998.3.2.73).
[11] L. Brown, M. Holmes, A. Jones, “The application of transcutaneous electrical nerve stimulation to acupuncture points (Acu-TENS) for pain relief: a discussion of efficacy and potential mechanisms”, Physical Therapy Reviews, vol. 14, no. 2, pp 93-103, April. 2009 (doi.org/10.1179/174328809X405964).
[12] A.W. Rutjes, E. Nuesch, R. Sterchi, L. Kalichman, E. Hendriks, M. Osiri, L. Brosseau, S. Reichenbach, P. Jüni, “Transcutaneous electrostimulation for osteoarthritis of the knee”, Cochrane Database of Systematic Reviews, vol. 7, no. 4, Oct. 2009 (doi.10.1002/14651858.CD002823.pub2).
[13] H. Burri, V. Piguet, “UninTENSional pacemaker interactions with transcutaneous electrical nerve stimulation”, Europace, vol. 11, no. 3, pp. 283–284, Mar. 2009 (doi: 10.1093/europace/eup008).
[14] Y. Coldron, E. Crothers, J. Haslam, W. Notcutt, T. Watson, R. Thomas, D. Sidney, “ACPWH guidance on the safe use of transcutaneous electrical nerve stimulation (TENS) for musculosketal pain during pregnancy”, 2007 (www.electrotherapy.org/downloads/Modalities/TENS in pregnancy guidelines.pdf).
[15] K.E. Nnoaham, J. Kumbang, “Transcutaneous electrical nerve stimulation (TENS) for chronic pain”, Cochrane Database of Systematic Reviews, vol. 16, no. 3, July 2008 (doi: 10.1002/14651858.CD003222.pub2).
[16] J.M. Bjordal, M.I. Johnson, R.A. Lopes-Martins, B. Bogen, R. Chow, A.E. Ljunggren, “Shortterm efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials”, BMC Musculoskeletal Disorders, vol. 8, no. 51, June 2007 (doi: 10.1186/1471-2474-8-51).
[17] G. Cruccu, T.Z. Aziz, L. Garcia-Larrea, P. Hansson, T.S. Jensen, J-P. Lefaucheur, B.A. Simpson, R.S. Taylor, “EFNS guidelines on neurostimulation therapy for neuropathic pain”, European Journal of Neurology, vol. 14, no. 9, pp. 952-970, Oct. 2007 (doi: 10.1111/j.1468-1331.2007.01916.x).
[18] C.I. Price, A.D. Pandyan, “Electrical stimulation for preventing and treating post-stroke shoulder pain: A systematic cochrane review”, Clinical Rehabilitation, vol. 15, no. 1, pp. 5–19, Feb. 2001 (doi: 10.1191/026921501670667822).
[19] S. Jena, C.M. Witt, B. Brinkhaus, K. Wegscheider, S.N. Willich, “Acupuncture in patients with headache”, Cephalalgia, vol. 28, no. 9, pp. 969–979, Sept. 2008 (doi.org/10.1111/j.1468-2982.2008.01640.x).
[20] A. Khadilkar, D.O. Odebiyi, L. Brosseau, G.A. Wells, “Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain”, Cochrane Database of Systematic Reviews, vol. 4, no. 4, Feb. 2008 (doi: 10.1002/14651858.CD003008.pub3).
[21] S. Poitras, L. Brosseau, “Evidence-informed management of chronic low back pain with transcutaneous electrical nerve stimulation, interferential current, electrical muscle stimulation, ultrasound, and thermotherapy”, Spine Journal, vol. 8, no. 1, pp. 226-233, Jan.–Feb. 2008 (doi: 10.1016/j.spinee.2007.10.022).
[22] L.A.C. Machado, S.J. Kamper, R.D. Herbert, C.G. Maher, J.H. McAuley, “Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials”, Rheumatology (Oxford), vol. 48, no. 5, pp. 520–527, Dec. 2008 (doi: 10.1093/rheumatology/ken470).
[23] M.I. Bennett, N. Hughes, M.I. Johnson, “Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: low fidelity may explain negative findings”, Pain, vol. 152, no. 6, pp. 1226–1232, June 2011 (doi: 10.1016/j.pain.2010.12.009. Epub 2011 Mar 23).
[24] S. Hasan, “Comparative Study: Analgesic effect of Al-TENS in variation of treatment time on experimentally induced ischaemic pain in healthy young adult”, Indian Journal of Physiotherapy and Occupational Therapy, Vol. 7, No. 2, pp. 255-260, Jan. 2013 (doi:10.5958/J.0973-5674.7.2.051).
[25] H.O. Handwerker, G. Kobal, “Psychophysiology of experimentally induced pain”, Physiological Reviews, Vol. 73, No. 3, pp. 639-671, July 1993 (doi: 10.1152/physrev.1993.73.3.639).
[26] P.A. Moore, G.H. Duncan, D.S. Scott, J.M. Gregg, J.N. Ghia, “The submaximal effort tourniquet test: its use in evaluating experimental and chronic pain”, Pain, Vol. 6, No. 3, pp. 375-382, May 1979 (doi: 10.1016/0304-3959(79)90055-1).
[27] J.T. Farrar, J.P. Young Jr, L. LaMoreaux, J.L. Werth, R.M. Poole, “Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale”, Pain, Vol. 94, No. 2, pp. 149-158, Nov. 2001 (doi: 10.1016/S0304-3959(01)00349-9).
[28] C.C. Chen, M.I. Johnson, “Differential frequency effects of strong nonpainful transcutaneous electrical nerve stimulation on experimentally induced ischemic pain in healthy human participants”, Clinical Journal of Pain, Vol. 27, No. 5, pp. 434-441, Mar. 2011 (doi: 10.1097/AJP.0b013e318208c926).
[29] M. Ebrahimian, M. Razeghi, A. Zamani, Z. Bagheri, K. Rastegar, A. Motealleh, “Does high frequency transcutaneous electrical nerve stimulation (TENS) affect EEG gamma band activity?”, Journal of Biomedical Physics and Engineering, Vol. 8, No. 1, pp. 271-280, Sept. 2018 (doi:10.31661/jbpe.v8i3sep.780).
[30] K.A. Sluka, C.G. Vance, T.L. Lisi, “High-frequency, but not low-frequency, transcutaneous electrical nerve stimulation reduces aspartate and glutamate release in the spinal cord dorsal horn”, Journal of Neurochemistry, Vol. 95, No. 6, pp. 1794-1801, Dec. 2005 (doi: 10.1111/j.14714159.2005.03511.x).
[31] G. Leonard, P. Goffaux, S. Marchand, “Deciphering the role of endogenous opioids in high-frequency TENS using low and high doses of naloxone”, Pain, Vol. 151, No. 1, pp. 215-219, Oct. 2010 (doi: 10.1016/j. pain.2010.07.012).
