Neuromuscular electrostimulation techniques: historical aspects and current possibilities in treatment of pain and muscle waisting

Abstract

Application of electricity for pain treatment dates back to thousands of years BC. The Ancient Egyptians and later the Greeks and Romans recognized that electrical fishes are capable of generating electric shocks for relief of pain. In the 18 th and 19 th centuries these natural producers of electricity were replaced by man-made electrical devices. This happened in following phases. The first was the application of static electrical currents (called Franklinism), which was produced by a friction generator. Christian Kratzenstein was the first to apply it medically, followed shortly by Benjamin Franklin. The second phase was Galvanism. This method applied a direct electrical current to the skin by chemical means, applied a direct and pulsed electrical current to the skin. In the third phase the electrical current was induced intermittently and in alternate directions (called Faradism). The fourth stage was the use of high frequency currents (called d'Arsonvalisation). The 19 th century was the "golden age" of electrotherapy. It was used for countless dental, neurological, psychiatric and gynecological disturbances. However, at beginning of the 20 th century electrotherapy fell from grace. It was dismissed as lacking a scientific basis and being used also by quacks and charlatans for unserious aims. Furthermore, the development of effective analgesic drugs decreased the interest in electricity. In the second half of the 20 th century electrotherapy underwent a revival. Based on animal experiments and clinical investigations, its neurophysiological mechanisms were elucidated in more details. The pain relieving action of electricity was explained in particular by two main mechanisms: first, segmental inhibition of pain signals to the brain in the dorsal horn of the spinal cord and second, activation of the descending inhibitory pathway with enhanced release of endogenous opioids and other neurochemical compounds (serotonin, noradrenaline, gamma aminobutyric acid (GABA), acetylcholine and adenosine). The modern electrotherapy of neuromusculo-skeletal pain is based in particular on the following types: transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS or electro-acupuncture) and spinal cord stimulation (SCS). In mild to moderate pain, TENS and PENS are effective methods, whereas SCS is very useful for therapy of refractory neuropathic or ischemic pain. In 2005, high tone external muscle stimulation (HTEMS) was introduced. In diabetic peripheral neuropathy, its analgesic action was more pronounced than TENS application. HTEMS appeared also to have value in the therapy of symptomatic peripheral neuropathy in end-stage renal disease (ESRD). Besides its pain-relieving effect, electrical stimulation is of major importance for prevention or treatment of muscle dysfunction and sarcopenia. In controlled clinical studies electrical myostimulation (EMS) has been shown to be effective against the sarcopenia of patients with chronic congestive heart disease, diabetes, chronic obstr...

Efficacy of neuromuscular electrostimulation intervention to improve physical function in haemodialysis patients

“…However, electric current may occasionally cause discomfort or pain. Typically, a mild tingling sensation is the most commonly reported adverse effect caused by electric current [6][7][8][9]27]. In the present study, no NMES-related adverse effects or dropouts were recorded.…”

“…These impulses stimulate the nerves to send signals to a specifically targeted muscle, which reacts by contracting, as it would with normal muscular activity [6,7]. It is widely Abstract Background Haemodialysis (HD) patients are characterised by muscle wasting, decreased physical function and poor quality of life.…”

Resultados de un programa de ejercicio físico combinado con electroestimulación neuromuscular en pacientes en hemodiálisis

“…Una menor evidencia científi ca se encuentra en relación al papel de la electroestimulación neuromuscular en el paciente renal, siendo muy limitados y escasos los estudios publicados en relación a éste tema (7)(8)(9)(10) . Merece la pena destacar un único estudio publicado a nivel nacional (8) en un grupo de 11 pacientes en programa de HD periódica que mostró una mejoría de la fuerza muscular, la capacidad funcional y la calidad de vida tras la realización de un programa de 5 semanas de duración de ejercicio físico de fuerza -resistencia asociado a electroestimulación neuromuscular de ambos cuádriceps en las sesiones de HD.…”

“…Ampliamente es utilizada en el ámbito de la de fi sioterapia en pacientes en programa rehabilitación muscular. Aunque carece de efectos adversos considerables, ésta corriente eléctrica, ocasionalmente puede ser dolorosa (9,10) .…”

“…Hasta la fecha, escasos estudios acerca del papel de la EENM sobre la fuerza muscular en los pacientes en HD han sido publicados (7)(8)(9) . Por tanto, en nuestro estudio pretendemos analizar el efecto de un programa de entrenamiento físico intradiálisis combinado con EENM sobre la fuerza muscular y la capacidad funcional en nuestros pacientes en HD y analizar la seguridad, efi cacia y tolerancia de la EENM en nuestros pacientes.…”