Reduced Analgesic Effect of Acupuncture-like TENS but Not Conventional TENS in Opioid-Treated Patients

Léonard, Guillaume; Cloutier, Christian; Marchand, Serge

doi:10.1016/j.jpain.2010.07.003

Cited by 54 publications

(28 citation statements)

References 39 publications

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“…However, Wang et al [29] showed decreased activity in the sympathetic nerves after electro-acupuncture stimulation, which was accompanied by a decrease in HRV and pain in healthy men. The reduction of HRV immediately after HF-HI electrical stimulation in the present study is similar to previous research results, confirming the reliability of HRV measurement results based on electrical stimulation variables [30].…”

Section: Discussionsupporting

confidence: 92%

Frequency and Intensity of Electrical Stimulation of Human Sympathetic Ganglia Affect Heart Rate Variability and Pain Threshold

Cho

2019

Applied Sciences

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Featured Application: This study evaluated the effects of electrical stimulation on the autonomic nervous system by evaluating heart rate variability (HRV) and the pain threshold in response to different conditions of interferential current (IFC) applied to the sympathetic ganglia. Different conditions of the frequency and intensity of electrical stimulation resulted in distinct changes in HRV and pain control duration. Therefore, an appropriate use of the frequency and intensity of electrical stimulation can be very important for its application in clinical treatments. Abstract:The study relates to the selection of effective clinical treatments based on the changes associated with each electrical stimulation condition. The aim was to investigate the effects of electrical stimulation on the autonomic nervous system by evaluating the heart rate variability (HRV) and pain threshold in response to different interferential current conditions applied to the sympathetic ganglia. Forty five participants were randomly assigned to receive high frequency-low intensity (HF-LI), low frequency-high intensity (LF-HI), or high frequency-high intensity (HF-HI) electrical stimulation. We then used bipolar adhesive pad electrodes to stimulate the thoracic vertebrae T1-T4 for 20 min, and changes were evaluated before, immediately after and 30 min after electrical stimulation. Results revealed significant HRV immediately after HF-LI and LF-HI electrical stimulations. This present study finding of a reduction in HRV immediately after HF-HI electrical stimulation confirms HRV measurement reliability based on electrical stimulation parameters. Results revealed a significant increase in the pain threshold with HF-HI electrical stimulation than for the other conditions; there was also a shorter pain duration. The present study also showed a significant effect of the HF-LI and LF-HI conditions on the pain threshold immediately after electrical stimulation, but the results after 30 min only revealed significant changes in the LF-HI group, indicating a maintenance of the pain control period immediately and 30 min after electrical stimulation. Different conditions of electrical stimulation resulted in distinct changes in HRV and pain control duration.

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Section: Discussionsupporting

confidence: 92%

Frequency and Intensity of Electrical Stimulation of Human Sympathetic Ganglia Affect Heart Rate Variability and Pain Threshold

Cho

2019

Applied Sciences

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“…Similar to animal studies, humans subjects with chronic pain that were opioid tolerant showed a reduced effectiveness of low frequency TENS, but not high frequency TENS. 26 This data again confirms and validates the prior animal studies that show low frequency TENS, but not high frequency TENS, is ineffective in animals with morphine tolerance. 45 We suggest understanding the mechanisms of opioid tolerance and how to alleviate opioid tolerance will not only assist in the delivery of opioid pharmaceutical agents, but will also prove useful for the effective delivery of TENS.…”

Section: Development Of Tolerancesupporting

confidence: 86%

Increasing Intensity of TENS Prevents Analgesic Tolerance in Rats

Sato¹,

Sanada²,

Rakel³

et al. 2012

The Journal of Pain

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Transcutaneous electrical nerve stimulation (TENS) reduces hyperalgesia and pain. Both low frequency (LF) and high frequency (HF) TENS, delivered at the same intensity (90% motor threshold (MT)) daily, result in analgesic tolerance with repeated use by the 5th day of treatment. Thecurrentstudytestedif 1) increasingintensityby 10% per daypreventsthedevelopmentoftolerance to repeated TENS, and 2) iflowerintensity TENS (50 % MT) produces an equivalentreduction in hyperalgesia when compared to 90% MT TENS. Sprague-Dawley rats with unilateral knee joint inflammation (3% carrageenan) were separated according to the intensity of TENS used: Sham, 50% LF, 50% HF, 90% LF, 90% HF, and increased intensity by 10% per day (LF and HF). The reduced mechanical withdrawal threshold following the induction of inflammation was reversed by application of TENS applied at 90% MT and increasing intensity for the first 4 days. On the 5th day, the groups that received 90% MT intensity showed tolerance. Nevertheless, the group that received an increased intensity on each day still showed a reversal of the mechanical withdrawal threshold with TENS. These results show that the development of tolerance can be delayed by increasing intensity of TENS.

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“…Clinical studies in human subjects confirm that opioid receptors play a role in TENS analgesia. These studies show release of endogenous opioids in human subjects during TENS, low and high frequency TENS analgesia is blocked by systemic naloxone and that TENS is less effective in patients who are opioid tolerant [27,39–40,54,56,63]. Clinically, 32% of long-term users of TENS with a variety of chronic pain conditions report a decline in TENS efficacy from the time the unit was issued [32].…”

Section: Discussionmentioning

confidence: 99%