Electrical stimulation for reducing trapezius muscle dysfunction in cancer patients : traditional treatment protocols also work

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Comparison of transcranial magnetic stimulation measures obtained at rest and under active conditions and their reliability

Transcranial magnetic stimulation (TMS) studies investigating motor cortex reorganization in clinical populations use a variety of measurements, with some performed at rest and others with the muscle slightly contracted. Surprisingly there are still a limited number of studies focusing on relationship between TMS-measures obtained at rest and during active muscle contraction in healthy individuals. The purpose of this study was to: 1) compare resting and active TMS-measures and assess their association; 2) determine their respective short- and long-term reliability. Motor threshold (MT), motor evoked potentials (MEP) amplitude, map area, normalized map volume, map center of gravity (CoG) and short-interval intracortical inhibition (SICI) of the first dorsal interosseous (FDI) muscle were assessed in 12 healthy subjects. Subjects were tested three times (with a short (four days) and a long (>1 month) inter-session interval). No significant difference was found between resting and active measures, except for MT. Active MT was on average at 82% of resting MT. Good short- and long-term reliability were found for MT and CoG (in resting and active conditions), for the SICI and MEP amplitude at rest and for the normalized map volume under active condition. In conclusion, maps of FDI muscle obtained at rest and during active contraction are very similar to each other in healthy individuals when differences in MT are taken into account. Most TMS measures present good reliability when obtained under the appropriate condition, with comparable short-term and long-term reliability

The Canadian Pain Society: A historical perspective

This article reviews the major features and events that have characterized the 40-year history of the Canadian Pain Society/Société canadienne de la douleur, which is a chapter of the International Association for the Study of Pain (IASP). The review first describes its early formative years in the 1970s as eastern and western chapters of IASP and then its evolution as a Canada-wide chapter and Society. Also highlighted is the formulation in this period of its purpose to foster pain research, education and management, and the many activities in which the Society has been engaged to reinforce this purpose over the ensuing decades. These include its annual scientific meetings, and the establishment of publications, guidelines, and other educational material as well as awards to support research and trainees, Many of these activities have included engagement with key partners who have also collaborated with the Society in national and international advocacy for pain. The review also outlines some of the features and factors underpinning the Society’s national and international reputation and impact resulting from the many contributions that its members have made to the advances in pain research, education and management over the past 40 years. The review concludes by noting that by way of its rich history and its past and present experiences, the Society is well-positioned to continue its many activities and contributions to address the many challenges still facing the pain field in Canada and around the world

Simple things matter! : how reassurance and pain management strategies can improve outcomes in physiotherapy : a case report

Abstract : Psychological barriers to rehabilitation are generally seen as preexisting patient traits that clinicians are asked to evaluate and modify. In the present case report, we provide evidence that these barriers can also be involuntarily created or perpetuated by the clinician himself when too much attention is placed on physical abnormalities. Without discarding the need to treat the presumed biological source of pain, these observations remind rehabilitation professionals about the importance of displaying a confident and reassuring attitude towards pain patients in order to reduce anxiety, promote physical activity and reinforce self-management strategies

Re: Sluka KA, Bjordal JM, Marchand S, Rakel BA. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature

Abstract : We read the article recently published by Sluka and colleagues1 in PTJ with great interest. The elements raised by the authors shed important light on the mixed results obtained in the literature concerning the analgesic effect of transcutaneous electrical nerve stimulation (TENS). In their article, Sluka and colleagues identified many factors that can affect TENS efficacy. We would like to take this opportunity to highlight 3 other important elements that can affect the analgesic effect of TENS and to remind physical therapists of the importance of considering these elements in their day-to-day practice

Reduced analgesic effect of acupuncture-like TENS but not conventional TENS in opioid treated patients

Abstract : Evidence from recent animal studies indicates that the analgesic effect of low frequency TENS is reduced in opioid tolerant animals. The aim of the present study was to compare the analgesic effect of conventional (high frequency) and acupuncture-like (low frequency) TENS between a group of opioid treated patients and a group of opioid-naive patients in order to determine if this cross-tolerance effect is also present in humans. Twenty-three chronic pain patients (11 who took opioids and 12 who did not) participated in the study. Participants were assigned in a randomized cross-over design to receive alternately conventional and acupuncture-like TENS. There was a significant reduction in pain during and after conventional TENS when compared to baseline for both the opioid and non-opioid group (p.09). The reduced analgesic effect of acupuncture-like TENS in opioid treated patients is coherent with previous animal studies and suggests that conventional TENS should be preferred in patients taking opioids on a regular basis. Perspective: This study shows that patients taking opioids on a regular basis are less susceptible to benefit from acupuncture-like TENS. This phenomenon is probably attributable to the fact that the analgesia induced by acupuncture-like TENS and opioids are mediated by the same receptors (i.e. μ opioid receptors)

Deciphering the role of endogenous opioids in high frequency TENS using low and high doses of naloxone

Abstract : Previous human studies have shown that the analgesic effect of high frequency TENS could not be reversed by low doses of naloxone. The aim of the present study was to reinvestigate the possible contribution of opioid receptors in high frequency TENS analgesia by using low (0.02 mg/kg) and high (0.14 mg/kg) doses of naloxone. Naloxone (high and low doses) and saline were administered intravenously to young healthy adults using a double-blind randomised cross-over design. For each visit, TENS (100 Hz, 60 sec) was applied for 25 minutes to the external surface of the left ankle. TENS intensity was adjusted to obtain strong but comfortable (innocuous) paresthesias. Experimental pain was evoked with a 1 cm2 thermode applied on the lateral aspect of the left heel. Subjective pain scores were obtained before, during and after TENS. Because preliminary analyses showed that the order of presentation affected the pattern of results, only the first visit of every participant could be analyzed without fear of contamination from possible carry-over effects. These revealed that TENS maintained its analgesic properties following the injection of saline (p<.001) and the injection of a low dose of naloxone (p<.05). However, when a high dose of naloxone was administered, TENS analgesia was completely blocked (p=.20). These results strongly suggest that high frequency TENS involves opioid receptors. An insufficient amount of opioid antagonist likely prevented previous human studies from discovering the importance of opioid receptors in producing high frequency/ low intensity TENS analgesia

Physiologie et physiopathologie des mécanismes endogènes de contrôle de la douleur

Tout le long de son trajet vers les centres supérieurs, le message nociceptif est soumis à une série de modulations pouvant augmenter ou diminuer la réponse nociceptive. Les mécanismes permettant de diminuer la réponse nociceptive revêtent un intérêt particulier pour les scientifiques et les cliniciens, d'une part parce que plusieurs approches analgésiques non-pharmacologiques reposent sur l'activation de ces mécanismes et, d'autre part, parce qu'il est possible qu'un dérèglement de ces mécanismes soit la source de certaines douleurs chroniques. Les présents projets de recherche se sont intéressés aux mécanismes inhibiteurs sous ces deux perspectives. Dans un premier temps, le rôle des récepteurs opioïdes dans l'analgésie induite par la neurostimulation périphérique (TENS)- une modalité électrothérapeutique reposant sur l'activation des mécanismes endogènes de contrôle de la douleur - ainsi que l'interaction entre le TENS et les opioïdes exogènes ont été étudiés. Ensuite, l'efficacité analgésique des mécanismes inhibiteurs descendants a été évaluée chez les patients souffrant de la névralgie du trijumeau afin de déterminer si un déficit de ces mécanismes pourrait être associé à cette condition douloureuse. MÉTHODOLOGIE : Trois protocoles de recherche distincts ont été utilisés afin de répondre aux divers objectifs. D'abord, 24 sujets ont participé à un projet de recherche où nous avons évalué l'effet de la naloxone (petite et grande dose) sur l'analgésie induite par le TENS conventionnel en utilisant un paradigme de douleur expérimental avec une thermode. Ce projet aura permis de répondre au premier objectif entourant le rôle des récepteurs opioïdes dans l'analgésie induite par le TENS. Afin de répondre au second objectif concernant l'interaction entre le TENS et les opioïdes exogènes, nous avons recruté 23 participants souffrant de douleur chronique (11 patients prenant régulièrement des opioïdes depuis plus de 4 mois et 12 patients n'ayant pris aucun opioïde depuis plus de 6 mois). Les 23 participants ont pris part à deux séances expérimentales au cours desquelles nous avons évalué l'effet du TENS conventionnel et acupuncture sur leur douleur clinique. Enfin, pour répondre au troisième objectif, nous avons comparé l'efficacité analgésique des contrôles inhibiteurs diffus nociceptifs (CIDN) entre un groupe de patients souffrant de névralgie du trijumeau classique, un groupe de patients souffrant de névralgie du trijumeau atypique et un groupe de participants sains. L'efficacité des CIDN (mécanisme inhibiteur descendant) a été évaluée en utilisant un paradigme de contre-irritation basé sur l'immersion du bras dans un bain d'eau froide. RÉSULTATS : Le premier projet de recherche a permis de révéler que l'effet analgésique du TENS conventionnel était complètement bloqué par l'administration d'une grande dose de naloxone. Au contraire, la petite dose de naloxone n'a pas réussi à renverser l'effet analgésique du TENS, suggérant que seules les grandes doses de naloxone sont capables de bloquer l'effet analgésique du TENS conventionnel. Pour le deuxième projet, nous avons observé une diminution des niveaux de douleur chez les patients du groupe opioïde et du groupe non-opioïde pendant et après l'application du TENS conventionnel. Pour le TENS acupuncture cependant, l'effet analgésique a uniquement été observé chez les patients du groupe non-opioïde. Finalement, le troisième projet de recherche a permis de montrer qu'il existait une différence importante entre les patients souffrant de névralgie du trijumeau classique, les patients souffrant de névralgie du trijumeau atypique et les participants sains pour ce qui est de l'efficacité des mécanismes inhibiteurs descendants. Spécifiquement, les participants sains et les patients souffrant de névralgie du trijumeau classique ont montré une diminution de douleur de 21 % et 16 %, respectivement, suivant l'immersion du bras dans le bain d'eau froide. Au contraire, il n'y eut aucune diminution de douleur chez les patients souffrant de la névralgie du trijumeau atypique. CONCLUSION : Les résultats des différents projets de recherche suggèrent (1) que l'effet analgésique du TENS conventionnel est lié au relâchement d'opioïdes endogènes (2) que l'efficacité analgésique du TENS acupuncture est diminuée chez les patients prenant régulièrement des opioïdes et (3) que l'efficacité analgésique des mécanismes inhibiteurs descendants est diminuée chez les patients souffrant de névralgie du trijumeau atypique. Ensemble, ces résultats permettent de mieux comprendre les mécanismes neurophysiologiques du TENS et lancent de nouvelles hypothèses concernant les processus physiopathologiques associés à la névralgie du trijumeau

Rheological analysis of granular systems applied to the study of electrostatic effects

This doctoral research aims to deepen knowledge on the impact of electrostatic forces on powder rheology. The initial focus of this thesis was to answer the following question:"Does the presence of electrostatic charges on a pharmaceutical powder carrier have an influence on the spatial lubricant distribution over the carrier particles and thus on the granular rheology?". After the development of an electrification setup and many experiments, the answer to this question turns out to be negative. However, this question led us to discover several phenomena, such as deformation mechanisms of powder columns during shear tests with the FT4 rheometer; and the formation of self-assemblies after the imposition of electrostatic charges on pharmaceutical excipients. These phenomena are explored in this thesis. Therefore, we demonstrate the inability of a FT4 rheometer to conduct shear tests when pharmaceutical formulations are lubricated with magnesium stearate. Indeed,"monolithic cake" behaviour appears. Two numerical models (method of characteristics and analysis of Janssen) are used to assess the stress state and explain this particular case. In addition, a characterization of the shape and particle size distribution of the electrostatic self-assemblies is presented in this thesis. Finally, the previous parts of this thesis showed the importance of wall friction effects during shear tests. Thus, a final part of this thesis focuses on the mechanism of wall lubrication.This latest effort brings us back to the study of the influence of electrostatic forces on powder rheology. Indeed, a high variability with the wall friction results is obtained with unlubricated powders at a relative humidity of 20%. The presence of magnesium stearate and/or higher humidity conditions reduces this variability. However, some tests indicate that electrostatic phenomena are part of the explanation

Non-invasive stimulation techniques to relieve abdominal/pelvic pain: is more always better?

Chronic abdominal and pelvic pain is a common condition that has significant impact on quality of life, and causes billions of dollars in direct and indirect costs. Emerging data suggest that transcranial direct current stimulation (tDCS), alone or in combination with transcutaneous electrical nerve stimulation TENS), could be a promising therapeutic avenue to reduce chronic pain. The encouraging results coming from these studies prompted us to try combining TENS and tDCS in 4 of our patients who suffered from chronic abdominal/pelvic pain and to compare the effect with 5 other patients who received TENS alone. Pain intensity was assessed with a visual analog scale before, during and after the stimulation. We observed that there was a slight decrease in pain which was similar in both patient groups (TENS alone and TENS combined with tDCS). These observations suggest that combining TENS and tDCS in patients suffering from chronic pelvic and/or abdominal pain produces no additional benefit, compared to TENS alone. Future studies, looking at the effect of several/consecutive TENS and tDCS sessions should be conducted