Spinal cord stimulation (SCS) is one of the most effective modalities for management of refractory neuropathic pain unresponsive to conservative therapies. The SCS has been successful in providing analgesia, improving function, and enhancing quality of life for patients suffering from chronic pain conditions such as failed back surgery syndrome, complex regional pain syndrome, ischaemic and phantom limb pain, and coronary artery disease. This technique has proven to be cost effective in the long term despite its high initial cost. In this review article, we discuss the history of SCS development, mechanism of action, and indications for SCS.
Cost-Benefit Analysis ; Electric Stimulation Therapy ; adverse effects ; economics ; methods ; Failed Back Surgery Syndrome ; therapy ; Humans ; Treatment Outcome

OBJECTIVETo study the efficacy and safety of patient-controlled sedation with transcutaneous electrical stimulation of auricular Shenmen (TF4) in cesarean section.

METHODSA randomized controlled clinical trail was conducted on 180 singleton primiparas (SAS > 30) undergoing selective cesarean section. They were randomly assigned to three groups, i. e., the patient-controlled sedation with transcutaneous electrical stimulation of auricular Shenmen (TF4) group (Group A, 60 cases), the patient-controlled sedation with transcutaneous electrical stimulation of auricular eye point group (Group B, 60 cases), and the control group (Group C, 60 cases). Patients in Group A received patient-controlled sedation with transcutaneous electrical stimulation of auricular Shenmen (TF4) in the operating room. The strength was controlled by patients themselves. The stimulation lasted for 30 min before the epidural puncture till ending the surgery. Patients in Group B received stimulation of auricular eye point. Patients in Group C received pressurization with the same connected line as Group A, but without electric stimulation. The following indices were observed: (1) the bispectral index (BIS), heart rate (HR), mean arterial pressure (MAP), Ramsay sedation score when the women entered the operating room (T0), 30 min after stimulation (T1), at the time after removing the fetus (T2), and by the end of surgery (T3); (2) the concentrations of plasma angiotensin II (AngII) and cortisone (Cor) at the aforesaid time points; (3) the use rates of oxytocin, atropine, and ephedrine; the hemorrhage amount, and the neonatal Apgar score.

RESULTSCompared with Group A, the BIS, the plasma concentrations of AngII and Cor increased at T1, T2, and T3 (P < 0.05), and the Ramsay sedation score decreased (P < 0.05). The HR and MAP increased at T1 (P < 0.05) in Group B and Group C. Compared with T0, the BIS, HR, MAP, and Ramsay sedation score, the plasma concentrations of AnglI and Cor were lowered in Group A at T1 (P < 0.05). There was no statistical difference in the use rates of oxytocin, atropine, and ephedrine; the hemorrhage amount, and the neonatal Apgar score (P > 0.05).

CONCLUSIONSPatient-controlled sedation with transcutaneous electrical stimulation of auricular Shenmen (TF4) in cesarean section had obvious sedative effects. It had no adverse effects on puerperal or neonates.

Acupuncture Points ; Adult ; Analgesia, Patient-Controlled ; methods ; Cesarean Section ; methods ; Female ; Humans ; Pain Measurement ; Pregnancy ; Transcutaneous Electric Nerve Stimulation ; adverse effects ; methods

OBJECTIVETo observe the regulatory effect of transcutaneous electro-acupuncture (TCEA) for preventing intratracheal extubation stress response (IESR) in general anesthesia.

METHODSSixty patients with breast cancer scheduled to receive mastectomy were numbered according to their sequence of hospitalization, patients of odd number were assigned to the control group and those of even number to the treated group, 30 in each group. They were anesthetized by the same anesthesia approach, but TCEA was applied on patients in the treated group in the narcotic process by stimulating at Hegu (LI4) and Neiguan (PC6) of the diseased side for 20 min before induction; then on bilateral points of Hegu, Neiguan, Chize (LU5) and Lieque (LU7) all through the whole course of operation, but at time of 30 min before ending operation, stimulus at Chize and Lieque points stopped and turned to bilateral Shuitu (ST10) and Qishe (ST11) points. No management other than conventional anesthesia was applied on patients in the control group. Changes of blood pressure (MAP), heart rate (HR), plasma catecholamine and cortisol as well as the respiratory tract response occurred after extubation were observed and compared.

RESULTSHR, MAP, plasma levels of catecholamine and cortisol increased after extubation in both groups (P < 0.05), but the changes were more obvious in the control group than in the treated group (P < 0.05). Besides, the adverse reaction of respiratory tract occurred in the treated group was milder (P < 0.05).

CONCLUSIONSTCEA can alleviate the IESR to attenuate the adverse reaction of respiratory tract. It is definitely valuable in clinical practice.

Acupuncture Points ; Airway Extubation ; Anesthetics, General ; adverse effects ; Breast Neoplasms ; surgery ; Electroacupuncture ; methods ; Female ; Humans ; Mastectomy, Modified Radical ; Stress, Physiological ; Transcutaneous Electric Nerve Stimulation ; methods

PURPOSE: Existing data supports a relationship between pelvic floor dysfunction and lower urinary tract symptoms. We developed a survival model of pelvic floor dysfunction in the rabbit and evaluated cystometric (CMG), electromyographic (EMG) and ambulatory voiding behavior. MATERIALS AND METHODS: Twelve female adult virgin rabbits were housed in metabolic cages to record voiding and defecation. Anesthetized CMG/EMG was performed before and after treatment animals (n=9) received bilateral tetanizing needle stimulation to the pubococcygeous (PC) muscle and controls (n=3) sham needle placement. After 7 days all animals were subjected to tetanizing transvaginal stimulation and CMG/EMG. After 5 days a final CMG/EMG was performed. RESULTS: Of rabbits that underwent needle stimulation 7 of 9 (78%) demonstrated dysfunctional CMG micturition contractions versus 6 of 12 (50%) after transvaginal stimulation. Needle stimulation of the PC musculature resulted in significant changes in: basal CMG pressure, precontraction pressure change, contraction pressure, interval between contractions and postvoid residual; with time to 3rd contraction increased from 38 to 53 minutes (p=0.008 vs. prestimulation). Vaginal noxious stimulation resulted in significant changes in: basal CMG pressure and interval between contractions; with time to 3rd contraction increased from 37 to 46 minutes (p=0.008 vs. prestimulation). Changes in cage parameters were primarily seen after direct needle stimulation. CONCLUSIONS: In a majority of animals, tetanizing electrical stimulation of the rabbit pelvic floor resulted in voiding changes suggestive of pelvic floor dysfunction as characterized by a larger bladder capacity, longer interval between contractions and prolonged contraction duration.
Animals ; Disease Models, Animal ; Dystonia/*etiology ; Electric Stimulation/adverse effects/methods ; Electromyography/methods ; Female ; Muscle Contraction/physiology ; Pelvic Floor/*physiopathology ; Pelvic Floor Disorders/*complications/physiopathology ; Rabbits ; Urinary Bladder/physiopathology ; Urinary Retention/*etiology ; Urination/physiology ; Urine ; Vagina/*physiopathology

OBJECTIVETo evaluate the efficacy of transcutaneous electroacupoint stimulation with a train-of-four (TOF) mode for the prevention of postoperative nausea and vomiting (PONV) in the patients undergoing laparoscopic cholecystectomy.

METHODSNinety-six ASA Grade I - II patients scheduled for laparoscopic cholecystectomy were randomized into Neiguan (P6) electroacupoint stimulation group (treated group) and a placebo control group (placement of electrodes without electroacupoint stimulation). The anesthetic regimen was standardized by needling at Neiguan on the left side and connecting the TOF peripheral nerve stimulator. The incidence of nausea, vomiting, severity, antiemetic dosage and the degree of pain were assessed at 0, 60, 120 min, and 24 h after surgery.

RESULTSThe incidence of nausea and vomiting, the dose of antiemetics and the occurrence of severe nausea were all significantly lower in the treated group compared with the control group and the score for pain was obviously reduced in patients of the treated group at 24 h post-operation (P<0.05 or P<0.01).

CONCLUSIONTranscutaneous electroacupoint stimulation at P6 with the TOF mode could reduce the incidence and severity of nausea and vomiting with analgesic effects.

Acupuncture Points ; Adult ; Antiemetics ; therapeutic use ; China ; epidemiology ; Cholecystectomy, Laparoscopic ; adverse effects ; Female ; Humans ; Incidence ; Intraoperative Period ; Male ; Pain ; pathology ; Postoperative Nausea and Vomiting ; drug therapy ; epidemiology ; prevention & control ; Transcutaneous Electric Nerve Stimulation ; methods

The purpose of this study was to assess the effect of magnitopuncture stimuli for reducing driver mental stress and fatigue using power spectral analysis of the heart rate variability (HRV) and subjective evaluation. The experiments were divided into A-group and B-group. In both groups the subjects performed the simulator for 90 minutes under a vibration conditions with an erect sitting posture in a silent environment, and magnitopuncture was put on the acupoints when performing the task for one hour in A-group. In this study HRV exhibited a significant difference between the two groups after the simulating task (P < 0.05). A conclusion that magnitopuncture stimuli can reduce the driver mental stress and fatigue effectively was drawn.
Acupuncture Points ; Adult ; Automobile Driving ; Autonomic Nervous System ; physiopathology ; Electric Stimulation Therapy ; methods ; Fatigue ; therapy ; Heart Rate ; physiology ; Humans ; Magnetics ; therapeutic use ; Male ; Stress, Physiological ; therapy ; Vibration ; adverse effects

OBJECTIVETo evaluate the effect of electronic dental analgesia (EDA) device--Team Up Duo during ultrasonic scaling.

METHODSThe clinical trial was conducted as a randomized double-blind split-mouth design. Eighty-one patients requiring ultrasonic scaling were selected as subjects. Patients received treatment using the EDA device either in an active or an inactive state in paired quadrants. The patients scored their pain/discomfort levels with visual analog scale (VAS) after each procedure and filled a questionnaire.

RESULTSIn questionnaire, 79.0% patients felt EDA could relieve pain/discomfort during ultrasonic scaling. But the double-blind test showed that Team Up Duo was effective in 46.9% patients overall. The effective rate was 55.1% and 34.4% in groups with or without attachment loss, respectively. In CP group, the success rate of EDA was not statistically significantly different between the groups according to sex, age or site.

CONCLUSIONSWhen using Team Up Duo during ultrasonic scaling, most patients subjectively believed that it was effective for controlling pain. In fact, this EDA device was effective in partial patients.

Adolescent ; Adult ; Aged ; Child ; Dental Scaling ; methods ; Double-Blind Method ; Female ; Humans ; Intraoperative Complications ; prevention & control ; Male ; Middle Aged ; Pain ; prevention & control ; Surveys and Questionnaires ; Transcutaneous Electric Nerve Stimulation ; instrumentation ; Ultrasonic Therapy ; adverse effects ; Young Adult

OBJECTIVETo observe the effects of gamma-aminobutyric acid (GABA) on the electric activities of pain-excited neurons (PEN) in nucleus accumbens (NAc) in central nervous system (CNS) of morphine-dependent rats.

METHODSAfter GABA or the GABA(A)-receptor antagonist, bicuculline (Bic), was injected into cerebral ventricles or NAc, right sciatic nerve was stimulated by electrical pulses, which was considered as traumatic pain stimulation. Extracellular recordings methods were used to record the electric activities of PEN in NAc.

RESULTSWhen GABA was injected into intracerebroventricle (ICV) as well as NAc, it could decrease the pain-evoked discharge frequency and prolong the latency of PEN. Bic could interdict the above effects of GABA on the electric activities of PEN.

CONCLUSIONExogenous GABA might have an inhibitory effect on the central pain adjustment. Furthermore, GABA and GABA(A) receptor participate and mediate the traumatic information transmission process in CNS.

Action Potentials ; drug effects ; physiology ; Animals ; Bicuculline ; pharmacology ; Disease Models, Animal ; Drug Administration Schedule ; Electric Stimulation ; adverse effects ; Female ; GABA Antagonists ; pharmacology ; Injections, Intraventricular ; methods ; Male ; Morphine ; administration & dosage ; Morphine Dependence ; etiology ; pathology ; physiopathology ; Narcotics ; administration & dosage ; Nucleus Accumbens ; metabolism ; physiopathology ; Pain ; etiology ; physiopathology ; Pain Threshold ; drug effects ; physiology ; Rats ; Rats, Wistar ; Reaction Time ; drug effects ; physiology ; Time Factors ; gamma-Aminobutyric Acid ; metabolism ; pharmacology

PURPOSE: This study was conducted to investigate the effectiveness of pelvic floor muscle exercise using biofeedback and electrical stimulation after normal delivery. METHODS: The subjects of this study were 49 (experimental group: 25, control group: 24) postpartum women who passed 6 weeks after normal delivery without complication of pregnancy, delivery and postpartum. The experimental group was applied to the pelvic muscle enforcement program by biofeedback and electrical stimulation for 30 minutes per session, twice a week for 6 weeks, after then self-exercise of pelvic floor muscle was done 50-60 repetition per session, 3 times a day for 6 weeks. Maximum pressure of pelvic floor muscle contraction (MPPFMC), average pressure of pelvic floor muscle contraction (APPFMC), duration time of pelvic floor muscle contraction (DTPFMC) and the subjective lower urinary symptoms were measured by digital perineometer and Bristol Female Urinary Symptom Questionnaire and compared between two groups prior to trial, at the end of treatment and 6 weeks after treatment. RESULTS: The results of this study indicated that MPPFMC, APPFMC, DTPFMC were significantly increased and subjective lower urinary symptoms were significantly decreased after treatment in the experimental group than in the control group. CONCLUSIONS: This study suggested that the pelvic floor muscle exercise using biofeedback and electrical stimulation might be a safer and more effective program for reinforcing pelvic floor muscle after normal delivery.
Adult ; Analysis of Variance ; Biofeedback (Psychology)/*methods ; Combined Modality Therapy ; Delivery, Obstetric/adverse effects/methods ; Electric Stimulation/*methods ; Exercise Therapy/*methods ; Female ; Humans ; Korea ; Muscle Contraction ; Nursing Evaluation Research ; Parity ; *Pelvic Floor/physiopathology ; Pregnancy ; Puerperal Disorders/etiology/physiopathology/*prevention & control ; Risk Factors ; Treatment Outcome ; Urinary Incontinence, Stress/etiology/physiopathology/*prevention & control ; Urodynamics

OBJECTIVETo investigate effects of acute maximal electroshock (MES) and chronic transauricular kindled seizures on learning abilities in Sprague-Dawley rats.

METHODSAn acute MES was induced by giving an alternating current (150 mA, 0.2 s) through ear-clip electrodes. Chronic transauricular kindled seizure was induced by repeated application of initially subconvulsive electrical stimulation (40 mA, 0.2 s) through ear-clip electrodes once every 24 h. An 8-arm radial maze (4 arms baited) was used to measure learning abilities. Histamine, glutamate and gamma-aminobutyric acid (GABA) were measured by high-performance liquid chromatography (HPLC).

RESULTIn the acquisition learning process, an acute MES increased reference memory errors but not working memory errors. In addition, it increased GABA levels in the hippocampus. On the other hand, chronic transauricular kindled seizures increased both working and reference memory errors in retrieval memory process, and this lasted for at least 3 weeks. Chronic transauricular kindled seizures induced CA1 neuron damage and a decrease in histamine levels in the hippocampus.

CONCLUSIONDifferent types of kindling seizure produce different effects on cognitive behavior: (1) an acute MES impairs learning ability, which may be associated with an abnormal plasticity and an increase of GABA in the hippocampus; (2) the chronic transauricular kindled seizure impairs retrieval memory mainly, which may be related to CA1 neuron damage and a decrease in histaminergic activity in the hippocampus.

Animals ; Chronic Disease ; Electric Stimulation ; instrumentation ; methods ; Electrodes ; Electroshock ; adverse effects ; Hippocampus ; metabolism ; Histamine ; metabolism ; Kindling, Neurologic ; physiology ; Learning Disorders ; etiology ; metabolism ; physiopathology ; Maze Learning ; physiology ; Memory Disorders ; etiology ; metabolism ; physiopathology ; Rats ; Rats, Sprague-Dawley ; Seizures ; complications ; physiopathology ; gamma-Aminobutyric Acid ; metabolism