Reflex inhibition of the quadriceps muscle group is a frequent and significant consequence of knee trauma, disease and surgical insult. The resultant quadriceps atrophy can be expected to delay rehabilitation and render the joint vulnerable to repeated injury resulting in capsular and synovial thickening, effusion and pain. A major purpose of this study was to examine the degree of quadriceps inhibition experienced by patients who undergo arthroscopic menisectomy. A secondary goal of this study was to investigate the efficacy of transcutaneous electrical nerve stimulation on the relief of reflex inhibition. Tests were performed on 12 patients prior to, and on day 1 and day 2 post surgery. True and placebo treatments of transcutaneous electrical nerve stimulation were administered on day 1 and day 2 post surgery. Measurements were made on the injured and normal limb with the knee fixed at 38G of flexion. Motor unit activation was determined by the twitch interpolation technique. Reduced motor unit activation was considered indicative of quadriceps reflex inhibition. Testing demonstrated that at all times the injured leg was weaker than the normal leg (p=.OOl). Following surgery, strength of the injured limb was significantly less than its pre operative score (p=.Ol). No significant recovery of strength was observed during the first two days following surgery. Injured legs were characterized by significantly lower motor unit activation at all times of testing Cp=.003). Following surgery, motor unit activation for the injured leg was significantly lower than its pre operative value (p=.Ol). By day 2 post surgery, motor unit activation had recovered Cp=.05) and was similar to the pre operative values for that leg. Transcutaneous electrical nerve stimulation had no effect on strength or motor unit activation. Recovery following arthroscopic surgery is characterized by an initial loss of strength and motor unit activation. By day 2, isometric strength remains depressed, however motor unit activation returns to pre surgery levels. / Thesis / Master of Science (MSc)

No description available.

The problem of this study concerns the reduction of spasticity in physically handicapped persons with CP. The hypotheses tested were: that there would be no significant difference between the mechanical efficiency (ME) of persons with spastic CP following application of the TENS Unit and following application of the placebo unit; that there would be no significant difference between the ME of males with spastic CP, following application of the TENS Unit or the placebo unit, and the ME of females with spastic CP, following application of the TENS Unit or the placebo unit; and that there would be no significant interaction between the treatment factor and the gender category.

<p>Mainstream electrical stimulation therapies, e.g., spinal cord stimulation (SCS) and deep brain stimulation, use pulse trains that are delivered at rates no higher than 200 Hz. In recent years, stimulation of nerve fibers using kilohertz-frequency (KHF) signals has received increased attention due to the potential to penetrate deeper in the tissue and to the ability to block conduction of action potentials. As well, there are a growing number of clinical applications that use KHF waveforms, including transcutaneous electrical stimulation (TES) for overactive bladder and SCS for chronic pain. However, there is a lack of fundamental understanding of the mechanisms of action of KHF stimulation. The goal of this research was to analyze quantitatively KHF neurostimulation. </p><p>We implemented a multilayer volume conductor model of TES including dispersion and capacitive effects, and we validated the model with in vitro measurements in a phantom constructed from dispersive materials. We quantified the effects of frequency on the distribution of potentials and fiber excitation. We also quantified the effects of a novel transdermal amplitude modulated signal (TAMS) consisting of a non-zero offset sinusoidal carrier modulated by a square-pulse train. The model revealed that high-frequency signals generated larger potentials at depth than did low frequencies, but this did not translate into lower stimulation thresholds. Both TAMS and conventional rectangular pulses activated more superficial fibers in addition to the deeper, target fibers, and at no frequency did we observe an inversion of the strength-distance relationship. In addition, we performed in vivo experiments and applied direct stimulation to the sciatic nerve of cats and rats. We measured electromyogram and compound action potential activity evoked by pulses, TAMS and modified versions of TAMS in which we varied the amplitude of the carrier. Nerve fiber activation using TAMS showed no difference with respect to activation with conventional pulse for carrier frequencies of 20 kHz and higher, regardless the size of the carrier. Therefore, TAMS with carrier frequencies >20 kHz does not offer any advantage over conventional pulses, even with larger amplitudes of the carrier, and this has implications for design of waveforms for efficient and effective TES. </p><p>We developed a double cable model of a dorsal column (DC) fiber to quantify the responses of DC fibers to a novel KHF-SCS signal. We validated the model using in vivo recordings of the strength-duration relationship and the recovery cycle of single DC fibers. We coupled the fiber model to a model of SCS in human and applied the KHF-SCS signal to quantify thresholds for activation and conduction block for different fiber diameters at different locations in the DCs. Activation and block thresholds increased sharply as the fibers were placed deeper in the DCs, and decreased for larger diameter fibers. Activation thresholds were > 5 mA in all cases and up to five times higher than for conventional (~ 50 Hz) SCS. For fibers exhibiting persistent activation, the degree of synchronization of the firing activity to the KHF-SCS signal, as quantified using the vector strength, was low for a broad amplitude range, and the dissimilarity between the activities in pairs of fibers, as quantified using the spike time distance, was high and decreased for more closely positioned fibers. Conduction block thresholds were higher than 30 mA for all fiber diameters at any depth and well above the amplitudes used clinically (0.5 – 5 mA). KHF-SCS appears to activate few, large, superficial fibers, and the activated fibers fire asynchronously to the stimulation signal and to other activated fibers. </p><p>The outcomes of this work contribute to the understanding of KHF neurostimulation by establishing the importance of the tissue filtering properties on the distribution of potentials, assessing quantitatively the impact of KHF stimulation on nerve fiber excitation, and developing and validating a detailed model of a DC fiber to characterize the effects of KHF stimulation on DC axons. The results have implications for design of waveforms for efficient and effective nerve fiber stimulation in the peripheral and central nervous system.</p> / Dissertation

A dengue é uma arbovirose que ameaça mais de metade da população mundial. No momento existem duas vacinas, administradas por vias parenterais, aprovada ou em estudos clínicos, que podem conferir proteção parcial em regiões endêmicas, mas que ainda não estão sendo administradas em larga escala. Por outro lado, a utilização de vias de administração alternativas, como a via transcutânea (TC), pode ter um impacto importante na eficácia vacinal. A entrega de formulações vacinais pela via TC tem como vantagem a administração segura e não invasiva de antígenos vacinais e a composição celular específica da pele, rica em células apresentadoras de antígenos, como as células de Langerhans; O presente estudo demonstra que a via TC pode induzir respostas sorológicas vírus-específicas de forma eficiente quando utilizada para a administração de vacinas contra DENV baseadas em partículas virais. Portanto, novos estudos devem ser feitos considerando a TC como uma via de administração alternativa às vias parenterais para a administração de vacinas contra a dengue. / Dengue is an arbovirosis that threatens more than half the world\'s population. Currently there are two vaccines, both administered via parenteral routes, approved or in clinical trials, which provide partial protection but are not being administered on a large scale. On the other hand, the use of alternative routes of administration, such as the transcutaneous (TC) route, can have a significant impact on vaccine efficacy. Delivery of vaccine formulations via the TC route has the advantage of a safe and non-invasive administration method of vaccine antigens through the skin, that has a cell composition rich in antigen-presenting cells, such as the Langerhans cells. The present study demonstrates that the TC route can efficiently induce virus-specific serological responses when used for administration of DENV vaccines based on viral particles. Further studies should explore different dengue vaccines using the TC route as an alternative to parenteral administration routes.

O uso da Estimulação Elétrica Transcutânea do Nervo (TENS) vem sendo muito pesquisado em pós-operatórios, todavia os estudos não analisam se a TENS de baixa freqüência -- que estimula a liberação de opióides endógenos -- seria eficiente em promover analgesia preemptiva. Objetivo. Analisar se essa modalidade de TENS, aplicada antes de colecistectomias por laparotomia, poderia proporcionar analgesia preemptiva. Casuística e método. A pesquisa -- clínica, controlada, randomizada e duplamente encoberta -- foi realizada no Hospital São Domingos Sávio, e teve uma amostra de 50 pacientes, todas do sexo feminino: grupo preemptivo (n = 25) e placebo (n = 25). As pacientes do primeiro grupo foram submetidas à aplicação da TENS de baixa freqüência antes da cirurgia: e as do grupo placebo, a uma falsa estimulação. Houve a padronização do cloridrato de bupivacaína (0,5%) como droga anestésica, associado ao fentanil (2 ml) para a realização das colecistectomias; e da medicação analgésica utilizada no pós-operatório: dipirona, prescrita de 6 em 6 horas, e diclofenaco de sódio, como medicação de resgate. A intensidade de dor pós-operatória foi mensurada pela Escala Numérica de Mensuração da Dor (END), em 8 momentos (2½, 3½, 4½, 5½, 7, 8 e 16 horas após a indução do bloqueio anestésico, além de uma última verificação no momento da alta hospitalar), e pelo Questionário de Dor McGill (MPQ), aplicado 16 horas após a indução do bloqueio anestésico. Outrossim, o grau de satisfação das pacientes com o tratamento foi mensurado pela Escala de Satisfação do Paciente (ESP). Os dados foram analisados por meio de testes estatísticos descritivos, Teste de Mann-Whitney, Teste-t de Student para amostras não-pareadas e qui-quadrado, sendo o nível de significância de 5%. Resultados. A intensidade de dor, mensurada pela END, foi significantemente menor no grupo preemptivo nas terceira e quarta coletas. Não houve diferença significante quanto aos índices obtidos pelo MPQ, e nem quanto à satisfação das pacientes, o consumo de drogas analgésicas no pós-operatório e o tempo para o primeiro requerimento de diclofenaco de sódio. Conclusão. A TENS de baixa freqüência proporcionou analgesia preemptiva após colecistectomia por laparotomia. / Introduction. Transcutaneous Electrical Nerve Stimulation (TENS) has been searched in the postoperative period, however these studies don\'t analyze whether low frequency TENS -- that stimulates the release of endogenous opioids -- could be efficient to provide preemptive analgesia. Objective. The aim of this study was to verify whether low frequency TENS, applied before open cholecystectomies, could provide it. Cases and method. It was a controlled, randomized and double-blinded trial, carried out at the Hospital São Domingos Sávio (Aracaju city, Brazil), and had a sample of 50 patients: preemptive group (n = 25) and placebo (n = 25). The patients from the first group were submitted to the application of TENS before the surgery; and the placebo group to a false stimulation. There was the standardization of the bupivacaine (0,5 %) as anesthetic drug plus fentanyl (2 ml) for the accomplishment of the cholecystectomies; and of the analgesic medication used in the postoperative period: dipyrone, prescribed for every 6 hours, and diclofenac, only if the patients complained about pain. Pain intensity was measured by the Numerical Rating Scale (NRS), in 8 moments (2½, 3½, 4½, 5½, 7, 8 e 16 hours after inducing the anesthesia besides one last verification at the hospital discharge), and by the Brazilian version of the McGill Pain Questionnaire (Br-MPQ), applied 16 hours after inducing the anesthesia. Patient satisfaction level in relation to the treatment was measured by the Patient Satisfaction Scale (PSS). The data were analyzed by Mann-Whitney Test, unpaired t-test and qui-square, being significant, those data with p < 0,05. Results. Pain intensity, measured by the NRS, was lower in the preemptive group in the third and fourth verifications. There was no difference neither in relation to the indexes obtained with the Br-MPQ, nor the PSS, consume of analgesics in the postoperative and time for the first request of diclofenac. Conclusion. Low frequency TENS provided preemptive analgesia after open cholecystectomy.

A imunização transcutânea (IT) é uma técnica promissora de vacinação, na qual a formulação contendo o antígeno é aplicada sobre a pele para induzir resposta imune. O sucesso desse tipo de imunização ocorre devido à presença de células apresentadoras de antígenos (APCs) na epiderme viável, as quais são potentes estimuladoras de linfócitos T. Porém, é necessário que o antígeno transponha a barreira imposta pelo estrato córneo e atinja a epiderme viável em concentrações adequadas para que uma resposta imune efetiva seja induzida. Neste trabalho, a influência da iontoforese, método físico que utiliza uma corrente elétrica fraca para aumentar a penetração cutânea de fármacos, foi investigada pela primeira vez na IT. Sua associação com lipossomas, para direcionar a liberação do antígeno para a epiderme viável, e com nanopartículas de prata (NPAg), para potencializar a resposta imune, também foi avaliada pela primeira vez. A ovalbumina (OVA) foi utilizada como antígeno modelo e a injeção subcutânea de OVA como controle positivo da imunização. Foram obtidos lipossomas aniônicos contendo 5 mg/mL de OVA e catiônicos contendo 0,25 mg/mL de OVA, adicionados ou não de NPAg. Os lipossomas aniônicos apresentaram tamanho médio de aproximadamente 120 nm e eficiência de encapsulação da OVA de 78,4%. Os lipossomas catiônicos apresentaram tamanho médio de aproximadamente 260 nm e eficiência de encapsulação da OVA de 83,08%. A adição das NPAg não alterou significativamente o tamanho dos lipossomas, mas alterou o potencial zeta (de -7,5 mV para -14 mV para os lipossomas aniônicos e de +41 mV para +36 mV para os lipossomas catiônicos). As microscopias de força atômica e eletrônica de transmissão (MET) confirmaram a presença de vesículas lipossomais, sendo que a TEM mostrou as NPAgs dispersas no meio aquoso externo dos lipossomas aniônicos e no meio aquoso interno dos lipossomas catiônicos. A OVA e os lipossomas se mostraram estáveis ao processo de obtenção e frente a corrente elétrica. Nos estudos de penetração cutânea in vitro observou-se que a encapsulação da OVA nos lipossomas direcionou sua liberação para a epiderme viável. A associação com a iontoforese aumentou 108 vezes a liberação da OVA na epiderme viável quando lipossomas aniônicos contendo NPAg foram administrados e 92 vezes quando lipossomas catiônicos contendo NPAg foram administrados. A presença das NPAg nas formulações aumentou a quantidade de OVA na epiderme viável quando a iontoforese foi utilizada, mas diminuiu sua penetração passiva. As quantidades de OVA penetradas por iontoforese anódica e catódica a partir dos lipossomas aniônicos não foram significativamente diferentes. O coeficiente de penetração da OVA na epiderme viável a partir da iontoforese dos lipossomas aniônicos foi 1,6 vezes (na ausência de NPAg) e 39 vezes (na presença de NPAg) maior do que o dos lipossomas catiônicos. Nos experimentos de imunização transcutânea in vivo observou-se que as quantidades de OVA que penetraram a pele por iontoforese foram suficientes para induzir resposta imune humoral semelhante a induzida pela injeção subcutânea da OVA para os lipossomas aniônicos, na presença e ausência de NPAg, e para o lipossoma catiônico apenas na presença da NPAg, sugerindo que as NPAg, na presença de baixas concentrações de OVA, funcionam como adjuvantes imunológicos. A iontoforese anódica das formulações, assim como a injeção subcutânea da OVA, não estimularam resposta imune celular significativa. A iontoforese catódica, no entanto, induziu tanto resposta humoral como celular, além de estimular a produção de INF-? e o recrutamento de células apresentadoras de antígeno, tanto no baço como nos linfonodos inguinais. Sendo assim, a iontoforese de lipossomas contendo OVA e NPAg foi capaz de direcionar a liberação da OVA para a epiderme, induzir altos títulos de anticorpos IgG1 e ainda ativar a resposta imune celular, sendo uma estratégia promissora para a IT. / Transcutaneous immunization (TI) is a promising strategy for vaccine in which the antigen-containing formulation is applied to the skin to induce immune response. The success of this type of immunization occurs due to the presence of antigen presenting cells (APCs) in the viable epidermis, which are potent stimulator of T lymphocytes. However, the antigen should transpose the barrier imposed by the stratum corneum to reach the viable epidermis in appropriate concentrations so that an effective immune response is induced. In this work, the influence of iontophoresis, a physical method that uses a weak electrical current to increase skin penetration of drugs, was investigated for the first time in TI. Its association with liposomes, to target the antigen release to the viable epidermis, and with silver nanoparticles (NPAg), to enhance the immune response, was also evaluated for the first time. Ovalbumin (OVA) was used as a model antigen and OVA subcutaneous injection as a positive control of immunization. Anionic and cationic liposomes containing 5 mg/ml and 0.25 mg/mL of OVA, respectively, were obtained and were added or not by NPAg. Anionic liposomes had an average size of approximately 120 nm and 78,4% OVA encapsulation efficiency. Cationic liposomes had an average size of approximately 260 nm and 83,08% OVA encapsulation efficiency. The addition of NPAg did not significantly alter the size of the liposomes, but changed the zeta potential (-7.5 mV to - 14 mV for anionic liposomes and +41 mV to +36 mV for cationic liposomes). The atomic force microscopy and transmission electron microscopy (TEM) confirmed the presence of liposomal vesicles; TEM showed NPAgs dispersed in the external aqueous medium of the anionic liposomes and in the internal aqueous medium of the cationic liposomes. The OVA and the liposomes were stable during the preparation process and in front of the electric current. In the in vitro skin penetration studies it was observed that the encapsulation of OVA into liposomes directed their release to the viable epidermis. The association with iontophoresis increased 108-fold the release of OVA in the viable epidermis when anionic liposomes containing NPAg were administered and 92-fold when cationic liposomes containing NPAg were administered. The presence of NPAg in the formulations increased the amount of OVA released in the viable epidermis when iontophoresis was applied, but decreased OVA passive penetration. The amount of OVA penetrated by anodic and cathodic iontophoresis of anionic liposomes was similar. The OVA penetration coefficient in the viable epidermis from the iontophoresis of anionic liposomes was 1.6-fold (in the absence of NPAg) and 39- fold (in the presence of NPAg) greater than the iontophoresis of cationic liposomes. In transcutaneous immunization in vivo experiments, it was observed that the amount of OVA that penetrated the skin by iontophoresis was sufficient to induce similar humoral immune response than that induced by subcutaneous injection of OVA when anionic liposomes, in the presence and absence of NPAg, and cationic liposome, only in the presence of NPAg, were administered. These results suggest that NPAg in the presence of low concentrations of OVA acted as immunological adjuvants. Altough induced humoral immune response; anodal iontophoresis of the formulations as well as subcutaneous injection of OVA did not stimulate significant cellular immune response. Cathodic iontophoresis, on the other hand, induced both humoral and cellular immune response, as well as stimulating the production of IFN-? and the recruitment of antigen presenting cells, both in spleen and in inguinal lymph nodes. Therefore, iontophoresis of liposomes containing OVA and NPAg was able to target the release of OVA to the epidermis, induce high titers of IgG1 and activate the cellular immune response, being a promising strategy for TI.

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