Bakgrund  Postoperative Nausea and Vomiting (PONV) är utöver smärta bland de vanligaste biverkningarna för patienter som genomgår anestesi i det postoperativa förloppet. Individuella riskfaktorer för PONV anses vara kvinnligt kön följt av tidigare historia av åksjuka, att vara icke-rökare och användning av postoperativa opioider. Förutom ökat vårdlidande och ökat vårdbehov är PONV associerad med ökad risk för aspiration, och försämrad sårläkning och längre sjukhusvistelse. Syfte  Syftet med litteraturstudien var att beskriva vilka effekter som framkommit för de icke- farmakologiska behandlingsmetoderna akupunktur, akupressur och transkutan elektrisk nervstimulering, mot postoperativt illamående och kräkningar hos vuxna. Metod  Systematisk litteraturstudie med beskrivande design valdes för att sammanställa resultat av relevant litteratur från tidigare studier gjorda inom problemområdet. Sökning av vetenskapliga artiklar gjordes i databasen PubMed. Efter urval och kvalitetsgranskning inkluderades 12 studier i resultatet. Granskning av de inkluderade artiklarnas kvalitet genomfördes utifrån rekommendationerna från Joanna Briggs Checklist for Randomized control trails.   Huvudresultat  Flera av de inkluderade studierna visade att de icke-farmakologiska behandlingsmetoderna akupunktur, akupressur och TENS hade signifikanta positiva effekter mot PONV, det första postoperativa dygnet hos framförallt kvinnor under 50 år. Slutsats  Utifrån de vetenskapliga artiklarna som har inkluderats i denna litteraturstudie, har det framkommit att de icke-farmakologiska behandlingsmetoderna akupunktur, akupressur och TENS har positiva effekter mot PONV hos framförallt kvinnor. Studien kan bidra till ökad förståelse för icke-farmakologiska behandlingsmetoder mot PONV. Därför bör icke-farmakologiska behandlingsmetoder betraktas som ett komplement till sedvanlig behandling mot PONV till patienter som genomgår anestesi i det postoperativa

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The primary aim of this study was to determine the effect of high frequency Transcutaneous Electrical Nerve Stimulation (TENS) on cold sensory function following topical application of menthol. Quantitative sensory testing was used to determine cold sensation and cold pain thresholds before and after topical application of a 40% menthol solution in 9 male and 11 female subjects. In a separate session the effect of TENS (100 HZ, constant pulse, 100µs, 20 minutes) was determined on menthol-induced cold sensation. Menthol produced a distinct cold hyperalgesia which was significantly reduced during the application of high frequency TENS. The analgesic effect of TENS persisted beyond the application period for at least 20 minutes. Menthol also reduced cold detection thresholds but TENS had no effect on this aspect of cold sensation. These data support the use of TENS as a means of treating cold hyperalgesia such as that found in neuropathic pain states.

The primary aim of this study was to determine the effect of high frequency Transcutaneous Electrical Nerve Stimulation (TENS) on cold sensory function following topical application of menthol. Quantitative sensory testing was used to determine cold sensation and cold pain thresholds before and after topical application of a 40% menthol solution in 9 male and 11 female subjects. In a separate session the effect of TENS (100 HZ, constant pulse, 100µs, 20 minutes) was determined on menthol-induced cold sensation. Menthol produced a distinct cold hyperalgesia which was significantly reduced during the application of high frequency TENS. The analgesic effect of TENS persisted beyond the application period for at least 20 minutes. Menthol also reduced cold detection thresholds but TENS had no effect on this aspect of cold sensation. These data support the use of TENS as a means of treating cold hyperalgesia such as that found in neuropathic pain states.

<p>Otillräcklig smärtlindring och läkemedelsbiverkningar är ett stort problem i den postoperativa vården. Smärtan i sig kan också leda till olika postoperativa komplikationer. Komplementära metoder är idag efterfrågade och börjar också integreras i vården. Syftet med denna litteraturstudie var att undersöka om sjuksköterskan kan använda sig utav akupunktur, aromaterapi, massage, musik och TENS vid postoperativ smärta. Frågeställningarna som sedan ställdes var då, kan komplementära metoder minska smärta postoperativt, minska opioidanvändningen samt påverka andra smärtrelaterade symtom i kroppen, såsom andningsfrekvens, blodtryck, puls och hormoner i kroppen? Arbetet gjordes som en litteraturstudie där 22 kvantitativa artiklar granskades. Resultetet delades in i kategorier utefter vilka metoder som studerats i artiklarna. Litteraturstudiens resultat visar att komplementära metoder såsom, akupunktur, aromaterapi, massage, musik och TENS har smärtlindrande egenskaper samt höjer välbefinnandet hos patienterna. Det sågs också en minskning i opioidanvändning samt påverkan på vissa andra smärtrelaterade symtom. Mer forskning behövs för att ytterligare utreda de komplementära metodernas plats i den postoperativa vården. Redan idag finns forskning som indikerar att komplementära metoder fungerar effektivt som smärtlindring och eftersom de saknar/har få biverkningar bör de kunna införas och integreras i sjukvården.</p>

Otillräcklig smärtlindring och läkemedelsbiverkningar är ett stort problem i den postoperativa vården. Smärtan i sig kan också leda till olika postoperativa komplikationer. Komplementära metoder är idag efterfrågade och börjar också integreras i vården. Syftet med denna litteraturstudie var att undersöka om sjuksköterskan kan använda sig utav akupunktur, aromaterapi, massage, musik och TENS vid postoperativ smärta. Frågeställningarna som sedan ställdes var då, kan komplementära metoder minska smärta postoperativt, minska opioidanvändningen samt påverka andra smärtrelaterade symtom i kroppen, såsom andningsfrekvens, blodtryck, puls och hormoner i kroppen? Arbetet gjordes som en litteraturstudie där 22 kvantitativa artiklar granskades. Resultetet delades in i kategorier utefter vilka metoder som studerats i artiklarna. Litteraturstudiens resultat visar att komplementära metoder såsom, akupunktur, aromaterapi, massage, musik och TENS har smärtlindrande egenskaper samt höjer välbefinnandet hos patienterna. Det sågs också en minskning i opioidanvändning samt påverkan på vissa andra smärtrelaterade symtom. Mer forskning behövs för att ytterligare utreda de komplementära metodernas plats i den postoperativa vården. Redan idag finns forskning som indikerar att komplementära metoder fungerar effektivt som smärtlindring och eftersom de saknar/har få biverkningar bör de kunna införas och integreras i sjukvården.

Background: Neuromuscular electrical stimulation (NMES) is increasingly being usedoutside the realms of physical therapy. Acknowledged as an efficient method to enhancestrength parameters, athletes are increasingly using NMES to facilitate training andstrength gains. A review was designed with a systematic approach with the mainobjective: to assess the effectiveness of transcutaneous NMES on maximal strength inphysical education students, trained and elite athletes in studies involving isometricNMES and Dynamic NMES. Method: A search for all types of trials was performed onPubmed, Sportdiscus, Web of Science Core Collection and The Cochrane ControlledTrials Register, and results were recorded according to the PRISMA recommendations.Twenty-one studies were included and judged for risk of bias and quality according tothe Cochrane guidelines and GRADE. Results: Studies were judged as having either anunclear or high risk of bias. All studies were judged as ‘very low level’ according toGRADE and were lacking bias-limiting methods, detailed information of interventionsand general standardised procedures. Conclusion: Strength gains in physical educationstudents, trained or elite athletes from a training intervention involving either isometricNMES combined with or without voluntary exercise or dynamic NMES are inconclusivedue to the very low level of the quality of the studies. Meta-analysis performed in thisarea should be interpreted with caution as the studies have been judged as eitherunclear or high risk of bias.Key words: isometric NMES (electrical stimulation applied to relaxed muscle), dynamicNMES (electrical stimulation superimposed onto voluntary contractions), strength.

A fisioterapia é uma área medicina veterinária com um crescente interesse científico, da mesma forma que sua aplicação em pequenos animais. Em cães, entre as indicações da reabilitação está o pós-operatório ortopédico recente, em que os objetivos principais são o controle álgico e da inflamação, possibilitando um restabelecimento funcional precoce. Dentre as afecções ortopédicas, a ruptura de ligamento cruzado cranial é a mais comum na articulação fêmoro-tíbio-patelar em cães, sendo a técnica de nivelamento do platô tibial amplamente empregada. O presente estudo teve como objetivo a análise dos efeitos da eletroterapia e da laserterapia nos aspectos de dor e inflamação no pós-operatório recente da referida cirurgia ortopédica. Para esta avaliação, foi utilizada uma metodologia multimodal que incluiu escalas de dor unidimensional (ENV) e multidimensional (Glasgow), escalas de claudicação, análise cinética por baropodometria, análises perimétricas e termográficas da articulação. Vinte e quatro cães foram selecionados, sendo que efetivamente distribuídos e randomizados entre os grupos, 16. Dentre eles, 9 animais foram distribuídos no grupo Fisioterapia (F) e 7 no grupo Placebo(P). Os animais do grupo fisioterapia foram submetidos a 6 sessões de eletroterapia associada à laserterapia, enquanto os animais do segundo grupo submetidos a 6 sessões placebo. Ambos os grupos foram avaliados antes da cirurgia, no pós-operatório previamente às sessões e ao término das 6 sessões. O grupo fisioterapia teve benefícios evidenciados nas análises seriadas das escalas de dor, com valores de P=0,0156 e P=0,011, nos quesitos de ENV do avaliador e do cuidador respectivamente. Nas análises de dor através da escala de Glasgow, os valores de P=0.0272 na análise seriada do grupo tratado, confirmando a melhora deste grupo em relação ao controle, onde o resultado de P=0.4375. Porém, não foram observadas diferenças nos quesitos de escalas de claudicação, avaliação de edema através de perimetria, e, inflamação através da termografia, em relação ao grupo placebo. Na avaliação cinética, houve diferença na análise dos parâmetros de impulso vertical, tendendo à melhora do grupo fisioterapia, porém na análise do pico de força vertical, que é mais sensível, não houve diferença entre os grupos. Houve também a necessidade de resgate analgésico em três animais do grupo placebo, sendo que nenhum animal do grupo Fisioterapia necessitou de resgate. Conclui-se que os animais submetidos às sessões de fisioterapia tiveram melhor evolução nos quesitos de dor, além de não necessitarem de resgate analgésico. Não houve influência da laserterapia no controle da inflamação e do edema através dos métodos avaliados. Evidencia-se a necessidade de mais estudos sobre os resultados das técnicas de fisioterapia quando aplicadas à rotina clínica veterinária, especialmente, com um maior número de amostras / Physical therapy is a veterinary medicine area with a growing scientific interest, as its application in small animals. In dogs, among the physiotherapy indications is the recent orthopedic post operatory period, in order to control pain and inflammation to get an early functional recovery. Among the orthopedic diseases, the cranial cruciate ligament rupture is the most common disease in the femoral-tibio-patellar joint in dogs, and the tibial plateau leveling osteotomy, the to more common surgical approach. This study aimed to evidence the effects of electrotherapy and laser therapy on aspects of pain and inflammation in the post operatory of that recent surgery. For this evaluation were used multimodal methods that included unidirectional and multidirectional pain scales, lameness scales, kinetic analysis by baropodometry, perimeter and thermographic analysis. Twenty-four dogs were selected, which effectively distributed between the groups 16. Among them, 9 animals in physiotherapy group (F) 7 and the placebo group (P). Animals in the physical therapy group underwent 6 electrotherapy sessions associated with laser therapy, and the other group underwent 6 placebo sessions. Both groups were evaluated before surgery, in the post recent post operatory, before the treatment, and after 6 sessions. The physiotherapy group had benefits shown in the serial analysis of pain scales, with P = 0.0156 and P = 0.011 values for the treated group, for ENV questions of the evaluator and the owner, respectively. The pain analysis by the Glasgow scale, the values of P = 0.0272 in the serial analysis of the treated group, confirming the improvement of this group compared to the control group, which had the P = 0.4375. Despite of these findings, no differences were observed in the categories of lameness scales, edema assessment through perimetry and thermography. In the kinetic evaluation, there were differences in the analysis of vertical impulse parameters, tending to improve of the physiotherapy group, but in the analysis of vertical peak force, which is more sensitive, there was no difference between groups. There was also the need for analgesic rescue medication in three animals of the placebo group. We conclude that animals subjected to actual physical therapy sessions had improvement in pain scores, and do not require analgesic rescue. There was no influence on the swelling or on the inflammation through the methods used in this study. Further studies are needed, especially with a larger number of animals

Diabetes mellitus und seine Folgeerkrankungen haben aufgrund der hohen Prävalenz in der Bevölkerung eine starke medizinsche Relevanz. Dabei stellen die durch eine diabetische Neuropathie ausgelösten Schmerzen ein Herausforderung in der Schmerztherapie dar. Die Behandlung dieser Schmerzen mit TENS ist eine oft angewendete Therapieoption, welche jedoch in ihrer Wirksamkeit nicht ausreichend evidenzbasiert gesichert ist, da es methodenbedingt bei klinischen Studien zur Wirksamkeit der TENS-Therapie oft Zweifel an einer ausreichenden Verblindung gibt. Die vorliegende Studie untersuchte deshalb Mikro-TENS als Therapiealternative zur TENS-Behandlung im Rahmen einer einfach verblindeten, placebokontrollierten, klinischen Studie mit 41 Patienten. Die Placebokontrolle ist bei der Anwendung von Mikroreizstrom möglich, weil dieser unterhalb der Wahrnehmungsschwelle für sensible Nervenfasern liegt. Damit können die Patienten nicht zwischen MENS-Therapie und Placebo-Therapie unterscheiden. Die Diabetespatienten wurden über 4 Wochen in insgesamt 12 Sitzungen à 30 Minuten mit Mikro-TENS am distalen Fuß beidseits behandelt. Als Messgrößen dienten der PDI, der NPS, der ADS und die durchschnittliche Schmerzintensität auf einer numerischen Ratingskala von 0 bis 10. Diese Variablen wurden jeweils zu Beginn der Studie, direkt am letzten Behandlungstag und einen Monat nach der letzten Behandlung erhoben. Der PDI Score zeigte nach vierwöchiger Therapie eine durchschnittliche absolute Reduktion von 4,27 \\pm 4,17 in der Verum- und 3,79 \\pm 7,71 in der Placebogruppe. Eine mindestens 30 %ige Verbesserung des NPS- und PDI-Scores wurde als Ansprechen auf die Therapie gewertet. Insgesamt konnte bei circa 30 % der 40 Studienteilnehmer eine Therapieresponse festgestellt werden. Laut NPS sprachen nach vier Wochen Reizstromtherapie 6 von 22 Patienten in der Verumgruppe und 10 von 19 Patienten in der Placebogruppe auf die Therapie an. Die Unterschiede zwischen den Studiengruppen waren statistisch nicht signifikant. Letztlich konnte die Wirksamkeit von Mikroreizstromtherapie bei diabetischer Polyneuropathie nicht bestätigt werden. Mit einer größeren Fallzahl und damit größerer statistischer Power könnte möglicherweise ein geringer Unterschied im Therapieerfolg zwischen Placebo- und Verumbehandlung statistisch signifikant werden. Dieser Therapieeffekt wäre aber möglicherweise schmerztherapeutisch als nicht relevant einzuschätzen, da es sich mit 80 %iger Wahrscheinlichkeit (Power der vorliegenden Studie) um eine Reduktion von weniger als 15 Punkten im PDI handelt. Daher kann die Mikroreizstromtherapie zur symptomatischen Therapie bei schmerzhafter diabetischer Neuropathie (dPNP) nicht empfohlen werden. Auf die Wirksamkeit von TENS mit höheren Stromstärken zur Behandlung der dPNP kann anhand der vorliegenden Studie kein Rückschluß gezogen werden. Es profitieren dennoch circa 30 % der insgesamt 40 Studienteilnehmer von der Intervention. Da in der Schmerztherapie Ansprechraten auf eine Placebotherapie von 7 bis 49 % möglich sind, stellt TENS eine Möglichkeit dar, diesen Effekt zusätzlich mit relativ geringem Aufwand auszuschöpfen. Vorteile in der Therapie mit Reizstrom sind außerdem geringe Kosten, nahezu keine unerwünschten Nebenwirkungen und fast kein Vorliegen von Kontraindikationen. Damit ist diese zusätzliche Therapieoptionen der dPNP neben einer optimale Einstellung des Blutzuckers und einer medikamentösen Schmerztherapie nicht außer Acht zu lassen und die Wirksamkeit komplexer Therapieprogramme mit Langzeitreizstromtherapie sollte in weiteren kontrollierten klinischen Studien eruiert werden.

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