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Novel e-Health and m-Health Services
Published in Rajarshi Gupta, Dwaipayan Biswas, Health Monitoring Systems, 2019
An indicative use case is that of a system used for transcutaneous electrical nerve stimulation (TENS). TENS devices have been prescribed by doctors as an effective way to reduce or even eliminate pain, (e.g. back pain). The TENS devices work by sending tiny electrical signals through the skin to intercept pain signals from reaching the brain and help to release endorphins, the body’s own natural pain fighting chemical. For example, iTENS [27] harnesses the power of a smart phone to wirelessly sync with a Bluetooth-based electrotherapy device, instead of using a separate control unit and wires. This device works via an iPhone- or Android-based app. In that sense, iTENS comprises a mobile medical device accompanied by a mobile medical app, and indeed it is certified by FDA as such.
in vitro studies and clinical trials
Published in Ze Zhang, Mahmoud Rouabhia, Simon E. Moulton, Conductive Polymers, 2018
Cramp et al. (2000) reported increased laser Doppler blood flow in a double-blinded study of healthy subjects with the application of TENS. There was a significant increase in blood flow in the low-intensity TENS group compared with the control and high-frequency TENS groups at 3, 6, 9, 12, and 15 min after the start of treatment. Gilcreast et al. (1998) evaluated perfusion in 132 diabetic subjects that were nontobacco users, before and after ES. A group of subjects demonstrated a significant increase in transcutaneous oxygen measurement (27%, n = 35). Responders were older and more likely to have neuropathy, higher blood glucose levels (glycated hemoglobin 9%), and good perfusion to the forefoot (toe blood pressure 70 mmHg). TENS is considered to be one of the most common therapeutic modalities used in clinical practice for the relief of chronic and acute pain (Liebano et al. 2011). Some authors have observed that in addition to its analgesic effects, TENS can also alter skin temperature and increase blood flow (Atalay and Yilmaz 2009). This observation has led to various studies investigating the effect on the peripheral vascular system and how this facilitates tissue repair (Sherry et al. 2001). Some studies have shown that TENS significantly increases skin temperature with low-frequency (2–4 Hz) (Kaada et al. 1984) and high-frequency (75–100 Hz) TENS (Nolan et al. 1993), and in local blood flow (Kaada et al. 1984). Other studies suggested that when applied at the same intensity, low-frequency TENS enhanced blood flow levels more than high-frequency TENS (Cramp et al. 2000; Wikstrom et al. 1999).
The Electromagnetic Phenomena as Incitants
Published in William J. Rea, Kalpana D. Patel, Air Pollution and the Electromagnetic Phenomena as Incitants, 2018
William J. Rea, Kalpana D. Patel
Transcutaneous electric nerve stimulation (TENS) is a noninvasive treatment used in physiotherapy practice to promote analgesia in acute and chronic inflammatory conditions. High-frequency (HF) and low-frequency (LF) TENS were used in a study by Sabino.50 LF TENS had a longer-lasting effect than HF, partially due to the local release of endogenous opioids.
Manipulation of sensory input can improve stretching outcomes
Published in European Journal of Sport Science, 2018
Robyn A. Capobianco, Awad M. Almuklass, Roger M. Enoka
Transcutaneous electrical nerve stimulation (TENS) applied over the skin can mitigate pain via the gate control theory (Moran et al., 2011; Sluka & Walsh, 2003). At low stimulus intensities, TENS elicits a tingling sensation without a muscle contraction. If TENS activates at least some of the same sensory fibres that contribute to stretch tolerance, then the application of TENS during a stretching manoeuvre should enable at least a transient increase in flexibility. For example, eight weeks of stretching during the concurrent application of TENS was superior to stretching alone in increasing hamstring flexibility in adolescent soccer players with short-hamstring syndrome (Piqueras-Rodríguez, Palazón-Bru, & Gil-Guillén, 2016). However, two weeks of stretch training by young women produced no difference in hamstring flexibility for the stretch group compared with stretching + TENS (Maciel & Camara, 2008). The conflicting results of these two studies underscore the need for further investigation into the effects of adding TENS to a stretching protocol.
Device profile of Nerivio for the acute and preventive treatment of episodic or chronic migraine in patients 12 years and older
Published in Expert Review of Medical Devices, 2023
Mahsa Babaei, Alan M. Rapoport
An early hypothesis was developed according to the Gate Control Theory of Melzack and Wall [12]. They proposed that the activation of large, myelinated nerve fibers block the nociceptive pain signals carried by smaller unmyelinated fibers [12]. This is the principle of transcutaneous electrical nerve stimulation (TENS) units which work at one level in the spinal cord. Nerivio works via a different mechanism of action called conditioned pain modulation (CPM); it triggers a subthreshold conditioning stimulation in one body region which inhibits pain in another body area (so-called, ‘pain inhibits pain’ mechanism) [13]. TENS works via an ascending, local and temporal mechanism of action, based on activating A-beta (‘touch’) nerve fibers and temporarily blocks the ascending nociceptive message propagated by C-fiber nerves. This is, in part, because C fibers and A-beta fibers share the same ascending inter-neurons. On the other hand, REN embraces a descending, global and long-term mechanism of action based on activating nociceptive nerve fibers in a remote location in the upper brainstem, resulting in triggering CPM, which is descending and global [14,15]. Although the exact mechanism is unknown, CPM generally works through the activation of A-delta and C fibers [16,17]. Pathways through which CPM and TENS analgesia originate and work are within different areas of the central nervous system and are slightly different; each of these methods activate different types of opioid and alpha-adrenergic receptors. However, CPM can produce a large inhibitory effect on T cells in the dorsal horn of the spinal cord through affecting the descending pathways from medullary reticularis nucleus dorsalis. Thus, when applied in combination, TENS activates the descending pathways from periaqueductal gray/rostral ventromedial medulla. Maximal hypoalgesic effect is obtained by CPM activation, producing no additional hypoalgesia. This hypothesis remains to be confirmed in future experimental studies. As shown in further studies, CPM induces a more comprehensive pain inhibition than TENS [15]. This shows that different receptors are activated through these different methods. Moreover, as mentioned by Liebano et al. and others, stimulation setting of CPM and TENS are quite different in terms of the location of application, pulse frequency and other signal characteristics. Therefore, TENS and CPM endorse slightly different mechanisms of action [18].