A estimulação elétrica nervosa transcutânea ou TENS (como é conhecida pela abreviação do inglês: Transcutaneous Electrical Nerve Stimulation), é uma valiosa técnica clínica não invasiva, onde estímulos elétricos são aplicados na superfície da pele, para promover o alívio sintomático da dor de diversas origens. Os mecanismos de ação e os parâmetros utilizados com essa técnica vem sendo pesquisados na tentativa de se obter os melhores resultados possíveis. A polêmica sobre o assunto atingiu proporções dignas de uma revisão sistemática, com abordagem das teorias envolvidas na modulação da dor pela TENS, evidências clínicas e fisiológicas mais discutidas. As pesquisas atuais sugerem que a TENS pode produzir analgesia por diferentes mecanismos, sendo que as evidências revelam a preferência de parâmetros preferenciais individuais como determinante para o sucesso no tratamento da dor. / Transcutaneous electrical nerve stimulation or TENS is a valuable clinical technique no invasive, where electrical stimulus are applied on the skin surface to foment the symptomatic relief of pain from several origins. The action mechanisms and the parameters used with this technique are being researched on attempt to obtain the best results as possible. The polemics about the subject reached proportions deserved for a systematical review, with approaches of theories involved on pain modulation by TENS, clinical evidences and physiological more discussed the current surveys suggest that TENS may produce analgesia for different mechanisms, being that evidences reveal the preference of individual parameters as determinant for success on treatment of pain.

A Eletroestimulação nervosa transcutânea (TENS) é um recurso não invasivo que tem como principal finalidade o alívio da dor. A dor perineal pós-episiotomia é uma queixa frequente no puerpério que pode interferir em diversas atividades diárias das puérperas. O objetivo deste estudo foi avaliar o efeito da TENS de alta e baixa frequência no alívio da dor de puérperas pós-episiotomia. Trata-se de um estudo clínico, randomizado, controlado e duplo cego com placebo, composto por 32 puérperas submetidas ao parto normal com episiotomia. As participantes foram divididas em três grupos, TENS alta frequência (TAF), TENS baixa frequência (TBF) e TENS placebo (TP). Os eletrodos foram posicionados paralelamente, próximos a episiotomia, na região dos nervos pudendo e genitofemural. O grupo TAF recebeu frequência de 100 Hz e largura de pulso de 100 ?s e o grupo TBF recebeu frequência de 5 Hz com largura de pulso de 100 ?s. No grupo TP o aparelho permaneceu ligado, mas não emitiu estímulo elétrico. A duração da aplicação da TENS foi de 30 minutos. Inicialmente, foi preenchido o formulário de dados, composto pelas variáveis relacionadas à identificação das puérperas, dados sócio-demográficos, obstétricos, do trabalho de parto e parto atual, do recém-nascido e requisição e/ou consumo de recurso de alívio de dor. Foram realizadas quatro avaliações. A avaliação inicial ocorreu antes da TENS. As puérperas que referiram presença de dor na episiotomia responderam a escala visual numérica (EVN) na posição repouso e aos movimentos sentar e deambular. Na verificação da limitação funcional, as puérperas responderam questões referentes às atividades de vida diárias que estavam limitadas. A segunda avaliação foi iniciada imediatamente após a retirada da TENS, sendo aplicado a EVN nas mesmas atividades avaliadas anteriormente. Nos três grupos de estudo foi aplicado o instrumento da opinião da puérpera em relação ao uso da TENS. A terceira avaliação ocorreu após 30 minutos da retirada da TENS, houve nova avaliação da dor apenas para a posição repouso. A quarta avaliação foi realizada após se passarem 60 minutos da retirada da TENS, foi feita a última avaliação da dor na posição repouso. Na coleta de dados, um examinador ficou responsável pelas avaliações da dor e pelo preenchimento da ficha de avaliação e o outro pela aplicação da TENS. Foram utilizados testes estatísticos não paramétricos, com nível de significância de p <= 0.05. A análise descritiva foi usada para apresentação dos dados. Na análise intragrupo foi verificada nos grupos TAF e TBF diferença estatística significativa na intensidade da dor na posição repouso e nas atividades sentar e deambular, não houve diferença significativa nas avaliações analisadas no grupo TP. Nos resultados da análise intergrupo, houve diferença estatística significativa na posição repouso e sentar nos grupos TAF e TBF. Não foi verificada diferença estatística significativa entre os três grupos na atividade deambular. A TENS nas frequências alta e baixa demonstrou ser eficaz no alívio de dor das puérperas submetidas à episiotomia pós-parto normal, podendo ser utilizada na rotina das maternidades. / Transcutaneous electrical nerve stimulation (TENS) is a non-invasive method that has as main purpose the relief of pain. The perineal pain after episiotomy is a frequent complaint in the puerperium that can interfere in many daily activities of puerperae. The aim of this study was to evaluate the effect of high and low frequency TENS in postpartum pain relief after episiotomy. This is a clinical, randomized, controlled, double blind study with placebo, consisting of 32 puerperal women undergoing to vaginal delivery with episiotomy. The participants were divided into three groups, high frequency TENS (TAF), low frequency TENS (TBF) and TENS placebo (TP). The electrodes were placed parallel near episiotomy, in the region of the pudendal and genitofemoral nerves. The TAF group has received 100 Hz frequency and pulse width of 100 ?s and the TBF group received frequency of 5 Hz with pulse width of 100 ?s. In the TP group the device was connected but did not deliver the electrical stimulation. The duration of TENS application was 30 minutes. Initially, it was filled the form data\'s, composed of the variables related to the women\'s identification, data\'s socio-demographic, obstetric, labor and actual delivery, the newborn and request and/or consumption of pain relief resource. Four evaluations were done. The initial assessment occurred before TENS. The puerperae who reported pain in episiotomy responded the visual numeric scale (VNS) in the rest position and the movements sit and walk. In the verification of functional limitation, the puerperaes answered questions regarding the activities of daily living that were limited. The second evaluation was initiated immediately after removal TENS, being applied the EVN in the same activities previously assessed. In the three study groups was applied the instrument about the puerperae opinion regarding the use of TENS. The third assessment occurred 30 minutes after removal of TENS, there was a new pain assessment only for the rest position. The fourth assessment was carried out to pass 60 minutes from the removal of TENS, was done the latest assessment of pain in the rest position. In collecting data, one examiner was responsible by the assessment of pain and to completing the evaluation form and the other by application of TENS. It was used nonparametric statistics tests, with a significance level of p <= 0.05. Descriptive analysis was used for data presentation. In the intragroup analysis was observed in groups TAF and TBF statistically significant difference in pain intensity at rest position and activities sit and walk, no significant difference in the analyzed evaluations in the TP group. The results of the intergroup analysis, showed a statistically significant difference in resting position and sit in groups TAF and TBF. There isn\'t verified significantly different between the three groups in walking activity. TENS in the high and low frequencies has proven effective in relieving pain of the puerperae undergoing episiotomy after normal delivery, can be routinely used in the maternity routine.

Orientador: Guilherme Antonio Moreira de Barros / Resumo: Introdução: A migrânea é uma doença prevalente, multifatorial e hereditária cujo diagnóstico é clinico. Uma opção de tratamento não farmacológico que tem despertado interesse entre os estudiosos é a estimulação elétrica nervosa transcutânea convencional (TENS). Considerada uma forma não invasiva e segura de tratamento da dor que consiste na aplicação de ondas elétricas transcutâneas através de eletrodos aplicados à pele. Objetivo: Avaliar a eficácia analgésica de um dispositivo portátil, descartável e autoaplicável de TENS aplicado de forma domiciliar nos momentos das crises de migrânea, assim como o seu perfil de segurança e tolerabilidade. Método: Ensaio clínico randomizado controlado, duplo cego, com uso de placebo ativo, com alocação 1:1 e tipo de erro I = 0,05 e tipo de erro II = 0,20. A amostra foi composta por adultos com diagnóstico de migrânea em acompanhamento em ambulatório especializado e em uso de doses estáveis de medicamentos profiláticos, ou na ausência do emprego de qualquer terapia medicamentosa. A intensidade da dor foi mensurada pela escala visual analógica autoaplicada antes e após a intervenção. O tempo de seguimento da intervenção foi de quatro meses, com acompanhamentos mensais. Foi considerado estatisticamente significativo valores de p < 0,05. Resultados: Foram incluídos 74 participantes, alocados aleatoriamente em dois grupos com características homogêneas. O grupo intervenção apresentou diferença estatística de redução de três pontos do escore de d... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Migraine is a prevalent, multifactorial, hereditary disease whose diagnosis is clinical. Among the non-pharmacological treatment options that have attracted interest among scholars is conventional transcutaneous electrical nerve stimulation (TENS). It consists of a non-invasive and safe form of pain treatment based on the application of transcutaneous electrical waves through electrodes applied to the skin. Objective: To evaluate the analgesic efficacy of a portable, disposable and self-applied TENS device applied at home at times of migraine attacks, as well as its safety and tolerability profiles. Method: Randomized controlled clinical trial, double blind, with active placebo, with 1: 1 allocation and error type I = 0.05. The sample consisted of adults diagnosed with migraine in a specialized outpatient clinic and in the use of stable doses of prophylactic drugs or in the absence of any drug therapy. The pain intensity was measured by the self-applied analogue visual scale before and after the intervention. The follow-up time of the intervention was four months, with monthly follow-up. Values of p <0.05 were considered statistically significant. Results: A total of 74 participants were randomly assigned to two groups with homogeneous baseline characteristics. The intervention group had a statistical difference between three points of the pain score in the first month of the intervention and two points in the second month in relation to the placebo group. No pa... (Complete abstract click electronic access below) / Mestre

<p>Current challenges in neuronal tract tracing include sacrificing the animal, detailed sectioning of the brain, and cumbersome reconstruction of slices to gather information, which are very tedious, time consuming, and have low-throughput. In this regard, Manganese-enhanced Magnetic Resonance Imaging (MEMRI) has been an emerging methodology for fiber tract tracing <i>in vivo</i>. <i></i>The manganese ion (Mn²⁺) is paramagnetic and is analogous to calcium ions (Ca²⁺), which allows it to enter excitable cells through voltage-gated calcium channels, thereby reporting cellular activity in T₁-weighted MR images<i>. </i>Moreover, once the Mn²⁺enters the cell, it will move along the axon by microtubules, release at the synapse, and then uptake by post-synaptic neurons, hence revealing the pathway of Mn²⁺transportation. While most MEMRI neuronal tracing studies have focused on mapping circuitries within the brain, MEMRI has rarely been applied to trace peripheral nerve projections into the brain. </p><p>In this thesis, I will propose the use of MEMRI to trace vagal nerve projections into the central nervous system by showing enhancement of neuronal pathways with an optimized protocol. This protocol demonstrates <i>in vivo </i>monitoring of manganese transport into the brain from the nodose ganglion and shows how the enhancement in MR images can be promoted with vagus nerve stimulation (VNS). Additionally, I will present preliminary findings, for the very first time, that show the downstream projection of the sympathetic pathway from the brainstem. In sum, the technique presented in this thesis will shed light on the use of MEMRI to study the functional results of using clinically-based VNS settings</p>

Objetivo: Avaliar os efeitos da estimulação elétrica nervosa transcutânea (TENS) comparada com TENS placebo e grupo controle sobre a dor, função pulmonar, força muscular respiratória e medicações analgésicas no pós-operatório de cirurgias torácicas em uma Unidade de Tratamento Intensivo (UTI). Método: Pacientes entre 31 e 76 anos submetidos a toracotomia póstero-lateral, foram incluídos e alocados aleatoriamente em três grupos: TENS (GE), TENS placebo (GP) e controle (GC). O GE recebeu a aplicação da TENS (frequência=100 Hz, duração de pulso=100 μs, intensidade no nível sensorial, durante 30 minutos, três vezes ao dia, durante a internação na UTI), associada a fisioterapia convencional (respiratória e motora). No GP foi realizada a TENS placebo além de fisioterapia convencional; e o GC recebeu apenas a fisioterapia convencional. Os desfechos foram avaliados no pré-operatório, pós-operatório (PO), e 48 horas após a internação na UTI: dor através da Escala Visual Analógica, função pulmonar através de espirometria (VEF1 e CVF), força muscular respiratória através de manovacuometria (PImáx e PEmáx), e medicações através da análise dos prontuários. Resultados: Foram incluídos 45 pacientes, sendo 15 em cada grupo. Em relação a percepção dolorosa, não houve diferença entre os grupos (P=0,172), porém houve redução na dor após o término do primeiro atendimento no GE (4,7±3,2 vs. 3,3±2,6; P<0,05). Em relação a função pulmonar e força respiratória não houve diferença significativa entres os grupos nos momentos avaliados. Entretanto, nas avaliações intragrupo, observou-se melhora na CVF, todos os grupos apresentaram redução no momento PO e 48 horas comparado com o pré (P<0,001), e somente o GE promoveu um aumento na CVF nas 48 horas em relação ao PO (P<0,001). A PImáx e PEmáx diminuíram em todos os grupos comparando o pré com o PO e 48 horas (P<0,001). Não houve diferença entre os grupos em relação as medicações analgésicas, porém o GC apresentou maior consumo de morfina (p=0,037) e o GP maior consumo de paracetamol (p=0,035) 24 vs 48 horas, o que não foi alterado no GE. Conclusão: Não foi observado diferença entre os grupos em relação aos desfechos avaliados no pós-operatório de cirurgia torácica, porém, a TENS 13 promoveu redução da dor e aumento mais precoce da CVF, além disso, não promoveu aumento no consumo de medicação. / Objective: To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) compared to placebo TENS and control group on pain, pulmonary function, respiratory muscle strength and analgesic medications in the postoperative period of thoracic surgery in an Intensive Care Unit (ICU). Methods: Patients between 31 and 76 years submitted to postero-lateral thoracotomy, were included and randomly allocated into three groups: TENS (GE), TENS placebo (GP) and control (GC). The GE received TENS (frequency = 100 Hz, pulse duration = 100 μs, intensity at the sensory level for 30 minutes, three times a day during ICU stay), associated with conventional physiotherapy (respiratory and motor). In GP, TENS was performed in addition to conventional physiotherapy; And GC received only conventional physiotherapy. The outcomes were evaluated in the preoperative, postoperative (PO) or 24 hours, and 48 hours after ICU admission: Pain through Visual Analog Scale, pulmonary function through spirometry (FEV 1 and FVC), respiratory muscle strength Through manovacuometry (MIP and MEP), and medications through the analysis of medical records. Results: 45 patients were included, 15 in each group. Regarding pain perception, there was no difference between the groups (P = 0.172), but there was a reduction in pain after the end of the first treatment in the GE (4.7 ± 3.2 vs. 3.3 ± 2.6; P <0.05). Regarding pulmonary function and respiratory force, there was no significant difference between the groups at the moments evaluated. However, in the intragroup evaluations, improvement in FVC, all the groups had a reduction at the time PO and 48 hours compared to the pre (P <0.001), and only the GE promoted an increase in FVC at 48 hours in relation to PO (P <0.001). The MIP and MEP decreased in all groups comparing the pre with PO and 48 hours (P <0.001).There was no difference between the groups in relation to analgesic medications, however, the CG had higher morphine consumption (p = 0.037) and the GP had a higher paracetamol consumption (p = 0.035) 24 vs 48 hours, which was not altered in the GE. Conclusion: No differences were observed between the groups in relation to the outcomes evaluated in the postoperative period of thoracic surgery, however, TENS promoted pain reduction and earlier increase in FVC, in addition, did not promote increase in medication consumption.

Studies have indicated that approximately 30% of people with heart disease experience major depressive disorder (MDD). Despite strong clinical evidence of a link between the two diseases, the neurobiological processes involved in the relationship are poorly understood. A growing number of studies are revealing similar neuroanatomical and neurochemical abnormalities resulting from both depression and heart disease. The locus coeruleus (LC) is a group of neurons in the pons that synthesize and release norepinephrine, and that is known to play a significant role in depression pathobiology. For example, there is evidence that tyrosine hydroxylase (TH) is elevated in the LC in depression. In addition, there is evidence that the LC plays a role in cardiovascular autonomic regulation. The hippocampus is another region that exhibits abnormalities in both depression and heart disease. In this study, the levels of TH in the hippocampus and LC were examined in the guinea pig pressure-overload model of heart disease. TH levels were also measured in the pressure-overload model treated with vagal nerve stimulation, a new investigational therapeutic intervention in heart disease. This study found that there were no changes in TH levels in the LC or the hippocampus of the pressure-overload model or in the pressure-overload model treated with vagal nerve stimulation.

Pain is the oldest medical condition and has been referenced through the ages. TENS is a non-invasive treatment for pain. Despite conflicting reports of treatment outcomes, TENS has enjoyed widespread clinical utilization. Seminal work by Sluka and colleagues reported low frequency TENS produces anti-hyperalgesia through µ-opioid receptors and high frequency TENS produces anti-hyperalgesia through ä-opioid receptors in an animal model of inflammation. The experimental results suggested that pain can be reduced by both high and low frequency TENS but by differing opioid receptors. These important findings require translational experiments to be conducted in humans. Providing an adequate placebo for experimental investigation of any physical intervention presents as a challenge. An improvement in the placebo intervention is critical to ascertain the true effects of TENS on painful conditions. Clinical TENS experiments often only examine a single outcome - resting pain. Recent work suggests TENS is less effective on resting pain as compared to movement pain. Investigation to determine which outcome measures (pain at rest, movement pain, pain sensitivity, and function) are most likely to be affected by TENS in human subjects with pain are critical to inform the design of future studies. The least investigated parameter for application of TENS electrode site determination. One method of selection employs a technique of finding points on the skin with suspected lower impedance. To date, no literature exists to determine the effectiveness of this clinical practice and speculation has existed for decades regarding the existence of distinct electrical properties associated with specific points on the body. This series of experiments accomplishes the goals of improving the TENS placebo, testing established parameters from basic science experiments in a patient population, testing multiple outcome measures to direct future investigation; and examined the effect of electrode site selection in TENS analgesia. These experiments were the first to establish a placebo that can 100% blind the TENS examiner, to test this placebo in a patient population, and to show that although there are differences in impedance between optimal and sham sites, that this difference had no effect in the amount of analgesia produced by TENS.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 5 uppsatser.

Thesis (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Campus access only. Vita. Bibliography: 170-192.

Orientador: Vera Therezinha Medeiros Borges / Resumo: Objetivo: Avaliar a eficácia da aplicação da estimulação elétrica nervosa transcutânea (TENS) no controle da dor durante o período da dilatação do trabalho de parto. Método: Foi realizado um ensaio clínico, paralelo e randomizado. Sessenta e oito parturientes com gestação única, de baixo risco, no termo, com dilatação cervical ≥ 4 cm e ≤ 7 cm e sem uso de medicação analgésica prévia. Foram randomizadas em dois grupos: TENS (n=34) e placebo (n=34) e avaliados os desfechos primários (intensidade da dor após a intervenção, grau de desconforto e grau de satisfação materna) e secundários (uso de outros métodos não farmacológicos para alívio da dor, fármacos no parto vaginal, taxa de cesárea e duração do trabalho de parto). A TENS foi aplicada por 30 minutos, entre T10 – L1 e S2 – S4. A intensidade da dor e o grau de desconforto foram avaliados por meio da escala visual analógica (EVA) e o grau de satisfação materna por nota de 0 a 10. Considerando a diferença de 34% entre os grupos para detectar efetividade do tratamento e assumindo a margem de erro de 10% e confiabilidade de 95%, o tamanho amostral calculado foi de 34 parturientes por grupo. Os resultados foram analisados estatisticamente para comparação entre os grupos estudados, adotando-se o limite mínimo de significância de 95% (p<0,05) Resultados: No grupo TENS houve maior número de parturientes classificando a dor como leve/moderada (RR= 2,4; IC95%: 1,6-3,7), melhora do grau de desconforto (RR= 4,1; IC95%: 2,1-8,1), maior n... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objective: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) in the control of pain during the period of labor. Method: A clinical, parallel and randomized trial was performed. Sixty-eight parturients with single, low-risk pregnancies at term, with cervical dilatation ≥ 4 cm and ≤ 7 cm and without previous analgesic medication. They were randomized into two groups: TENS (n = 34) and placebo (n = 34) and primary outcomes (pain intensity after intervention, degree of discomfort and degree of maternal satisfaction) and secondary outcomes (use of other non-pharmacological methods for pain relief, vaginal delivery drugs, cesarean section rate and duration of labor). The TENS was applied for 30 minutes between T10 - L1 and S2 - S4. The intensity of the pain and the degree of discomfort were evaluated through the visual analogue scale (VAS) and the degree of maternal satisfaction by grade from 0 to 10. Considering the difference of 34% between the groups to detect treatment effectiveness and assuming the margin of error of 10% and reliability of 95%, the sample size calculated was 34 parturients per group. The results were statistically analyzed for comparison between the groups studied, adopting the minimum significance level of 95% (p <0.05). Results: In the TENS group, there was a higher number of parturients classifying pain as mild / moderate (RR = 2.4, 95% CI: 1.6-3.7), improvement in the degree of discomfort (RR = 4.1, 95% CI, (RR = 2.8, 95% CI: 1... (Complete abstract click electronic access below) / Mestre