Presentation on theme: "TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION IN OSTEOPOROSIS RELATED PAIN Sanjay Kalra, Bharti Kalra, Bharti Hospital, Karnal INDIA firstname.lastname@example.org."— Presentation transcript:
1TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION IN OSTEOPOROSIS RELATED PAIN Sanjay Kalra, Bharti Kalra,Bharti Hospital, KarnalINDIA
2BACKGROUND Pain is a common comorbid feature of osteoporosis. Many drugs are available to manage pain, but all have limited success.Adverse effects, drug interactions and geriatric nature of most patients limit the use of drugsThere is a need for non pharmacological means of symptom management.
3The first uses of electroanalgesia were recorded by Aristotle, Pliny and Plutarch, who reported application of electrical fish to pain sites.
5TENSTranscutaneous electrical nerve stimulation (TENS) is an electrical modality of pain relief (Chabel et al; 1997, Shealy 2003) .Considered gold standard amongst non pharmacological modalities of pain relief (Mc Quay et al;1997).
6No reports are available, however, on the use of TENS in osteoporosis PRESENT STATUSNo reports are available, however, on the use of TENS in osteoporosisNo reports are available on effect of TENS on varying symptoms such as burning, lancinating pain, deep pain, crawling sensation and allodynia.
7TENSTENS devices consist of electronic stimulus generator which transmits pulses to electrodes on skin for pain management .Electrical pulses may block transmission of pain fibres ( large diameter myelinated A vs non myelinated slow C fibres) or may stimulate release of endogenous opioids.
8STUDY DESIGNSingle blind, randomized, prospective, single centre study at Bharti Hospital, Karnal.To assess efficacy of TENS, compared with diclofenac, in subjects with osteoporosis and pain.To assess efficacy of TENS in different symptoms of pain.
9PATIENT POPULATION Diclofenac 50 mg b.d. x 3 weeks. 30 patients in group I:Diclofenac 50 mg b.d. x 3 weeks.Five o d/ EOD sittings of 15 min using sham electrodes with no stimulation.30 patients in group II5 o d/ EOD sittings of TENS.( Life Care, Ghaziabad, India)Duration, intensity of TENS decided on daily basis by physiotherapist (FREQUENCY ; hold: relax ratio modulation)
10STUDY DESIGN Osteoporosis management as routine No opioids, TCAs, SSRIs etc. given to TENS group.Supportive management as needed.Pain severity assessed by visual analog scaleValidated English language questionnaires used to assess physician communication, time spent in stretching/strengthening exercise, social/role activities limitation, cognitive symptom management, health distress score and energy/fatigue levels.
12TENS PARAMETERS Square Rectangular Sinusoidal Triangular /spiked WAVE FORMSBiphasic (containing both + ve and –ve waveforms).may be –SquareRectangularSinusoidalTriangular /spikedSelection depends on patient’s comfort.
13TENS PARAMETERS EOD to q6h (od or EOD) 15 mins to 1 hour (15 mins) FREQUENCY OF DOSINGEOD to q6h (od or EOD)DURATION OF SITTING15 mins to 1 hour (15 mins)FREQUENCYHz / 2-10 HzPULSE WIDTH / DURATIONµs ( µs)
15TENS PARAMETERSCURRENT – 60 mA ; treatment based on patients sensation (12 – 30 mA).CONSTANT CURRENT VS VOLTAGEconstant voltage.HOLD TIME10:1 to 1:1 ratio (6 to 9” hold 4 to 3” rest ratio)
16TENS PARAMETERS Associated nerve roots and dermatomes. Point of pain PLACEMENT OF ELECTRODESAssociated nerve roots and dermatomes.Point of painAcupuncture point proximal/distal to point of pain.Trans artheral placements ( knee & foot).Contra lateral placements in inaccessible areas due to amputations, dressings, open wounds & casts.
19MODULATION IN TENS frequency modulation Frequency modulation Pulse width modulationCurrent modulationMay vary about 10% periodically.(e.g 12 to 15 to 12 to 15 mA etc.)Hold: relax ratio modulationfrequency modulation
22DOSEThe dose of TENS used varied from 5.5 to 9.0 Hz on the initial day to 3.5 to 5.5 Hz on the last sitting. The dose varied insignificantly for different symptomsThis difference was maintained after 3 weeks, even though the TENS sittings had stopped
23Improvement inPhysician communication score :1.43 ± 1.19 to ± 0.86 over one month of therapy in all subjects.Time spent in stretching/strengthening exercise: ± 0.0 to 15.0 ± 0.0 min/week.social/role activities limitation : 2.25 ± 0.63 to ± 0.39.Cognitive symptom management : 1.30 ± 0.63 to ± 0.67.health distress score:3.20 ± 0.82 to 1.35 ± 0.47Energy/fatigue score: 2.25 ± 0.51 to 3.30 ± 0.50
24PCS= Physician communication score ,TSE= Time spent in stretching/strengthening exercise,SAL= social/role activities ,CSM= Cognitive symptom management, HDS=health distress score,EFS= Energy/fatigue score
25ConclusionTill date no study has tried to assess effect of TENS in osteoporosis-related pain.This study demonstrates the increased efficacy of TENS in osteoporosis with pain-related symptoms.The efficacy and efficiency of TENS as a therapeutic modality in persons with osteoporosis and pain is worthy of more extensive study.
26INDIAN SOCIETY FOR BONE AND MINERAL RESEARCH ACKNOWLEDGEMENTSSTAFF AND PATIENTSofBHARTI HOSPITALKARNALINDIAN SOCIETY FOR BONE AND MINERAL RESEARCH