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CPB - Diabetic Neuropathy: Selected Treatments discusses percutaneous electrical stimulation for the treatment of diabetic neuropathy Background The following are brief descriptions of various types of electrical stimulation discussed in this CPB, and a summary of available evidence: A TENS unit must be distinguished from other electrical stimulators e.
In theory, TENS stimulates sensory nerves to block pain signals; it also stimulates endorphin production to help normalize sympathetic function. Transcutaneous electrical nerve stimulation has been widely used in the treatment of various types of pain.
It has been shown that TENS is highly effective in alleviating pain and reducing analgesic medications following cesarean section, orthopedic and thoracic operations as well as mixed surgical procedures AHCPR, Moreover, TENS has been found to be beneficial also to those who suffer from acute musculoskeletal pain Long, On the other hand, the use of TENS in the treatment of chronic malignant pain is sparse and its effectiveness remains unproven.
For example, there are cancers that, through metastatic spread to the spine or pelvis, may elicit pain in the lower back as a symptom; and certain systemic diseases such as rheumatoid arthritis and multiple sclerosis manifest many debilitating symptoms of which low back pain is not the primary focus.
In an evidence-based review, the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology evaluated the effectiveness of TENS in the treatment of pain in neurological disorders Dubinsky and Miyasaki, The authors concluded that: They stated that further research into the mechanism of action of TENS is needed, as well as more rigorous studies for determination of efficacy.
In a Cochrane review, Mulvey et al evaluated the analgesic effectiveness of TENS for the treatment of phantom pain and stump pain following amputation in adults. Only randomized controlled trials RCTs investigating the use of TENS for the management of phantom pain and stump pain following an amputation in adults were included.
Two review authors independently assessed trial quality and extracted data. It was planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS.
No RCTs that examined the effectiveness of TENS for the treatment of phantom pain and stump pain in adults were identified by the searches.
The authors concluded that there were no RCTs on which to judge the effectiveness of TENS for the management of phantom pain and stump pain.
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The published literature on TENS for phantom pain and stump pain lacks the methodological rigor and robust reporting needed to confidently assess its effectiveness. They stated that further RCT evidence is needed before such a judgment can be made. Johnson et al updated of a Cochrane review published in on TENS for phantom pain and stump pain following amputation in adults.
They stated that further RCT evidence is needed before an assessment can be made. Since publication of the original version of this review, these investigators have found no new studies and their conclusions remain unchanged.
Zeng et al examined the effectiveness of different electrical stimulation ES therapies in pain relief of patients with knee osteoarthritis OA. Bayesian network meta-analysis was used to combine both the direct and indirect evidence on treatment effectiveness.
Interferential current is the only significantly effective treatment in terms of both pain intensity and change pain score at last follow-up time-point when compared with the control group.UBS Group AG is a Swiss multinational investment bank and financial services company founded and based in regardbouddhiste.com-headquartered in the cities of Zürich and Basel, it maintains a presence in all major financial centers as the largest Swiss banking institution in the world.
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