IntroductionTranscutaneous electrical nerve stimulation (TENS) is a noninvasive, inexpensive, self-administered technique used throughout the world to relieve pain. In Sri Lanka, physiotherapists may use TENS for their patients as they receive a small amount of education about the principles and practice of TENS in their undergraduate training. To date, there have been no data gathered about the use of TENS by physiotherapists in Sri Lanka. The aim of this study was to assess attitudes and beliefs of physiotherapists working in Sri Lanka about their use of TENS for pain management.MethodsA postal survey was undertaken using a 12-item questionnaire developed by the investigators to gather information about attitudes, beliefs and use of TENS in clinical practice. The questionnaire was distributed to 100 physiotherapists working in three government hospitals and six private hospitals in the cities of Kandy and Colombo. A descriptive analysis of data was performed.ResultsSixty-seven completed questionnaires were returned (67% response rate). Over half of the respondents (58.2%) reported that they used TENS to treat pain “often” or “very often”, with use for musculoskeletal/orthopedic (61.3%) and neuropathic/neuralgic (79.1%) pain being most common. TENS was used less for postsurgical pain and rarely for cancer pain. Most (95.5%) respondents reported that their patients benefitted “considerably” from TENS. 76.1% of the respondents reported that they did not recommend and/or prescribe TENS for patients to use at home.ConclusionPhysiotherapists value TENS as a treatment option to manage musculoskeletal and neuropathic pain. However, there is a need for systems and resources to enable to patients to self-administer TENS rather than having to visit clinics.

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We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function.

SUMMARY Up to 150 words summarising the case presentation and outcome (this will be freely available online) We present the case of a 46-year old woman who developed severe pain described as 'tearing' and 'searing' in the left side of mid-trapezius region near thoracic 8 vertebra (T8). The patient had undergone surgery for T8 fracture which had resulted from metastasis (secondary breast cancer). A community nurse referred the patient for physiotherapy assessment and treatment for her musculoskeletal pain and related symptoms that had affected her mobility and functional activities. The patient was treated with soft tissue therapy with the addition of kinesiology taping on follow-up visits. Kinesiology tape was applied over her left-side trapezius region and left shoulder. The patient reported significant reductions in pain severity and felt greater control and stability over her left shoulder region, which resulted in better function and overall quality of life measures. The patient did not report any adverse effects. BACKGROUND Why you think this case is important -why did you write it up?People with cancer especially in advanced stages have to cope with a number of distressing symptoms including pain, fatigue, lack of energy, oedema, dyspnoea and abdominal discomfort that result in reduced quality of life (1-4). Management of these symptoms is pharmacotherapy-led with a trade-off between symptom relief and adverse effects. Nonpharmacological interventions are often used in combination with medication to alleviate symptoms.Kinesiology taping involves the application of elasticated, thin, porous, water-resistant, cottonbased adhesive tape to the skin. It has become popular in recent times through its use by high profile elite sports people. The tape and technique was developed in 1970s for the management and rehabilitation of sports-related musculoskeletal injuries (5). Nowadays kinesiology taping is used by physical and sports therapists, osteopaths, chiropractors and nurses to manage musculoskeletal pain, cancer-related lymphedema and stroke-related spasticity (6, 7). Kinesiology tape is available without prescription in variety of shapes, sizes, colours and patterns (e.g. Kinesio® Tex Tape, Rocktape) and can be worn for up to 5 days whilst during normal activities of daily living including showering. Kinesiology taping differs from conventional taping and bandaging techniques that often use rigid zinc oxide tape because it does not restrict movement and appears to be better tolerated (8). Conventional taping techniques stabilise injuries by reducing loading and restricting movement of injured body parts. In contrast, kinesiology tape is applied to the skin under mild tension by stretching the tape and / or stretching the skin (e.g. by flexing or extending the joint). This provides a pulling force to the skin which may correct articular malalignments and influence proprioception and muscle function (9). It is also claimed that kinesiology taping "lifts" the epidermis to produce regions of decompression beneath...