Feasibility of Using Cranial Electrotherapy Stimulation for Pain in Persons with Parkinson's Disease

Objectives. To assess the feasibility of treating musculoskeletal pain in the lower back and/or lower extremities in persons with Parkinson's disease (PD) with cranial electrotherapy stimulation (CES). Design. Randomized, controlled, double-blind trial. Setting. Veterans Affairs Medical Center, Community. Participants. Nineteen persons with PD and pain in the lower back and/or lower extremities. Thirteen provided daily pain rating data. Intervention. Of the thirteen participants who provided daily pain data, 6 were randomly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks. They recorded their pain ratings on a 0-to-10 scale immediately before and after each session. Main Outcome Measure. Average daily change in pain intensity. Results. Persons receiving active CES had, on average, a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES (Wilcoxon Z = −2.20, P = .028). Conclusion. Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain. A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES. Guidelines for future studies are provided

Relationship Falls and Fear of Falling to Activity Limitations and Physical Inactivity in Parkinson\u27s Disease.

Aim: To investigate the relationships between falls, fear of falling, and activity limitations in individuals with Parkinson\u27s disease (PD). Design/methods: Cross-sectional study of individuals with mild to moderate PD (N = 83). Associations among demographic data, fall frequency, disease severity, motor impairment, ability to perform activities of daily living (ADL), Activities Balance Confidence Scale, Iowa Fatigue Scale, Comorbidity Index, and Physical Activity Scale for Elders were studied. Results: Frequent fallers had more ADL limitations than nonfallers (p \u3c .001) and rare fallers (p = .004). Frequent fallers reported a lower percentage of ability to perform ADL than nonfallers (p = .003). Frequent fallers and rare fallers were less physically active than nonfallers (p = .015 and p = .040, respectively). Frequent fallers and rare fallers reported a higher level of fear of falling than nonfallers (p = .031 and p = .009, respectively). Conclusions: Falls and fear of falling were associated with more ADL limitations and less physical activity after adjusting for physica

Efficacy of cranial electrotherapy stimulation for neuropathic pain following spinal cord injury: a multi-site randomized controlled trial with a secondary 6-month open-label phase

Background: Chronic pain is a significant problem for many individuals following spinal cord injury (SCI). Unfortunately, SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments. Cranial electrotherapy stimulation (CES) has been effective in managing some types of pain. It involves the application of a small amount of current through the head via ear clip electrodes. Objective: Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain. Study design: Multi-site, double-blind, sham-controlled study. Participants: Adults with SCI and chronic neuropathic pain at or below the level of injury were randomized to receive active or sham CES. Intervention: Application of active CES or sham CES 1 hour daily for 21 days. Six-month open-label phase to assess 'as-needed' CES use. Outcome measures: Change in pre-to post-session pain ratings as well as change in pain intensity, pain interference, pain quality, pain beliefs and coping strategies, general physical and mental health status, depressive symptomatology, perceived stress, and anxiety pre-to post-treatment. Results: The active group reported a significantly greater average decrease in pain during daily treatments than the sham group (Kruskal-Wallis chi-square = 4.70, P < 0.05). During the 21-day trial, there was a significant group × time interaction for only one outcome variable; the active group showed larger pre-to post-treatment decreases in pain interference than the sham group did (F = 8.50, P < 0.01, d = 0.59). Conclusions: On average, CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects. Individual results varied from no pain relief to a great deal of relief

Pain After Spinal Cord Injury: An Evidence-based Review for Clinical Practice and Research: Report of the National Institute on Disability and Rehabilitation Research Spinal Cord Injury Measures Meeting

Background/Objectives: To examine the reliability, validity, sensitivity, and practicality of various outcome measures for pain after spinal cord injury (SCI), and to provide recommendations for specific measures for use in clinical trials. Data Sources: Relevant articles were obtained through a search of MEDLINE, EMBASE, CINAHL, and PubMed databases from inception through 2006. Study Selection: The authors performed literature searches to find articles containing data relevant to the reliability and validity of each pain outcome measure in SCI and selected non-SCI populations. Data Extraction: After reviewing the articles, an investigator extracted information utilizing a standard template. A second investigator reviewed the chosen articles and the extracted pertinent information to confirm the findings of the first investigator. Data Synthesis: Taking into consideration both the quantity and quality of the studies analyzed, judgments on reliability and validity of the measures were made by the two investigators. Based upon these judgments, recommendations were formulated for use of specific measures in future clinical trials. In addition, for a subset of measures a voting process by a larger group of SCI experts allowed formulation of recommendations including determining which measures should be incorporated into a minimal dataset of measures for clinical trials and which ones need revision and further validity and reliability testing before use. Conclusions: A 0-10 Point Numerical Rating Scale (NRS) is recommended as the outcome measure for pain intensity after SCI, while the 7-Point Guy/Farrar Patient Global Impression of Change (PGIC) scale is recommended as the outcome measure for global improvement in pain. The SF-36 single pain interference question and the Multidimensional Pain Inventory (MPI) or Brief Pain Inventory (BPI) pain interference items are recommended as the outcome measures for pain interference after SCI. Brush or cotton wool and at least one high-threshold von Frey filament are recommended to test mechanical allodynia/hyperalgesia while a Peltier-type thermotester is recommended to test thermal allodynia/hyperalgesia. The International Association for the Study of Pain (IASP) or Bryce-Ragnarsson pain taxonomies are recommended for classification of pain after SCI, while the Neuropathic Pain Scale (NPS) is recommended for measuring change in neuropathic pain and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) for quantitating neuropathic and nociceptive pain discrimination

Determinants of Use of a Walking Device in Persons With Parkinson\u27s Disease

Objective To identify determinants for the use of a walking device in persons with Parkinson\u27s disease (PD). Design Cross-sectional study of participants with PD. Setting Laboratory. Participants Persons with PD (N=85; 60 men) were studied. Their mean age was 69.4±8.9 years. The average time since diagnosis was 7.9±5.3 years. Interventions Not applicable. Main Outcome Measures Age, sex, disease duration, disease severity, and motor impairment were recorded. Participants were asked whether they usually used any walking device (eg, cane or walker) and were categorized as either an “independent walker” or a “device walker.” Clinical balance measures including functional reach, turn duration, 5-meter timed Up and Go (5m-TUG) test, and Activities-specific Balance Confidence (ABC) scale were investigated for their contribution to the prediction of walking with a device. Results Thirty-one participants (36.5%) reported that they usually used a walking device. Classification and regression tree analysis determined that the 5m-TUG test and the ABC scale were important factors in differentiating participants who used a walking device from those who did not. Critical thresholds included 13 seconds for the 5m-TUG test and a score of 75 for the ABC scale in determining device walking. Using only these 2 determinants, the classification and regression tree model correctly classified 81% of the patients as either independent or needing a walking device. Conclusion The 5m-TUG test and the ABC scale may be useful in clinical assessments of the need for a walking device in persons with PD

Gait Variability in Parkinson\u27s disease: Levodopa and Walking Direction

BACKGROUND: Levodopa treatment has been shown to improve gait spatio-temporal characteristics in both forward and backward walking. However, effect of levodopa on gait variability during backward walking compared with forward walking has not been reported. AIMS OF STUDY: To study the effects of levodopa on gait variability of forward and backward walking in individuals with Parkinson\u27s disease (PD). METHODS: Forty individuals with PD were studied. Their mean age was 68.70 ± 7.46 year. The average time since diagnosis was 9.41 ± 5.72 year. Gait variability was studied while \u27OFF\u27 and \u27ON\u27 levodopa when the participants walked forward and backward at their usual speed. Variability in step time, swing time, stride length, double support time, and stride velocity were compared between medication condition and walking direction. RESULTS: Variability of step time, swing time, stride length, and stride velocity decreased significantly during forward and backward walks (P \u3c 0.001; P \u3c 0.001; P = 0.003, P = 0.001, respectively) after levodopa administration. Variability of double support time was not changed after levodopa administration (P = 0.054). CONCLUSIONS: Levodopa had positive effects on gait variability of forward and backward walking in individuals with PD. However, variability in double support time was not affected by the levodopa