scholarly journals Problems, Solutions, and Strategies Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews

2016 ◽  
Vol 96 (7) ◽  
pp. 1039-1048 ◽  
Author(s):  
Peter William Gladwell ◽  
Kathryn Badlan ◽  
Fiona Cramp ◽  
Shea Palmer
Keyword(s):  
Clinical Practice ◽  
Data Analysis ◽  
Musculoskeletal Pain ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Chronic Musculoskeletal Pain ◽  
Pain Clinic ◽  
Electrical Nerve Stimulation ◽  
Primary Data Analysis ◽  
Semistructured Interviews

Abstract Background Transcutaneous electrical nerve stimulation (TENS) could offer a non-drug form of pain relief, but there is no consensus regarding its effectiveness for chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methods identified significant problems with low treatment fidelity. There is little information available to inform the development of a pragmatic implementation design for a TENS evaluation. Objectives The aim of this study was to explore the experiences of patients who were receiving secondary care in a pain clinic and who had expertise in using TENS to manage chronic musculoskeletal pain. These key informants were selected because they had the potential to generate knowledge that could inform research design and clinical practice. Design A qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data. Methods Semistructured interviews were conducted with 9 patients (6 women, 3 men). Thematic analysis was used as the primary data analysis method, and this analysis was enhanced by a case-level analysis of the context and processes of TENS use of each individual. Results Data analysis indicated that patients learned to address a range of problems in order to optimize TENS use. Patients may need to personalize the positioning of electrodes and the TENS settings and to readjust them over time. Patients learned to use TENS in a strategic manner, and the outcomes of each strategy varied. Conclusions The findings indicated that a pragmatic TENS evaluation may need to incorporate a learning phase to allow patients to optimize this complex pattern of TENS usage, and evaluation may need to be sensitive to the outcomes of strategic use. These findings also have implications for clinical practice.

scholarly journals Direct and Indirect Benefits Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews

2015 ◽  
Vol 95 (11) ◽  
pp. 1518-1528 ◽  
Author(s):  
Peter William Gladwell ◽  
Kathryn Badlan ◽  
Fiona Cramp ◽  
Shea Palmer
Keyword(s):  
Data Analysis ◽  
Musculoskeletal Pain ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Chronic Musculoskeletal Pain ◽  
Pain Clinic ◽  
Electrical Nerve Stimulation ◽  
Indirect Benefits ◽  
Wide Range ◽  
Semistructured Interviews

Background There is no consensus regarding the effectiveness of transcutaneous electrical nerve stimulation (TENS) for management of chronic musculoskeletal pain or chronic low back pain. A recent review of previous trial methodology identified significant problems with low treatment fidelity. There is little information available to guide selection of patient-reported outcome measures appropriate for TENS evaluation. Objectives The purpose of this study was to explore the experiences of patients at a secondary care pain clinic who successfully used TENS to help manage chronic musculoskeletal pain. These key informants were selected because they had the potential to generate knowledge that could inform research design and clinical practice. Design A qualitative method using individual semistructured interviews with open questions was selected for its capacity to generate rich data. Methods A mini focus group informed the development of a discussion guide for semistructured interviews with 9 patients (6 women, 3 men). Thematic analysis was used as the primary data analysis method, and this analysis was enhanced by a case-level analysis of the context and processes of TENS use of each individual. Results Data analysis indicated that distraction from pain and a reduction in the sensations associated with muscle tension or spasm should be considered as separate outcomes from pain relief. These direct benefits led to a wide range of indirect benefits dependent on patient decision making, including medication reduction, enhanced function, psychological benefits, and enhanced ability to rest. Conclusions The findings indicate that evaluating TENS using a unidimensional pain scale is likely to overlook potential benefits. The complex pattern of TENS usage, as well as multiple direct and indirect outcomes, indicates that TENS could be considered as a complex intervention.

Electrical stimulation of peripheral and central pathways for the relief of musculoskeletal pain

1991 ◽  
Vol 69 (5) ◽  
pp. 697-703 ◽  
Author(s):  
M. Catherine Bushnell ◽  
Serge Marchand ◽  
Nicole Tremblay ◽  
Gary H. Duncan
Keyword(s):  
Electrical Stimulation ◽  
Deep Brain Stimulation ◽  
Musculoskeletal Pain ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Dorsal Column ◽  
Electrical Nerve Stimulation ◽  
Dorsal Column Stimulation ◽  
Deep Brain ◽  
Stimulation Of

One method for the treatment of chronic musculoskeletal pain involves stimulation of the peripheral or central nervous system. Such stimulation includes transcutaneous electrical nerve stimulation, dorsal column stimulation, and deep brain stimulation. This review discusses the clinical use of electrical stimulation for the relief of musculoskeletal pain, and describes the results of studies conducted in our laboratory suggesting that such stimulation reduces pain transmission along sensory-discriminative pathways.Key words: pain, nociception, transcutaneous electrical nerve stimulation, dorsal column stimulation, deep brain stimulation.

Understanding Athletic Trainers’ Knowledge, Intervention, and Barriers Toward Arthrogenic Muscle Inhibition

2021 ◽  
pp. 1-9
Author(s):  
Justin L. Rush ◽  
David A. Sherman ◽  
David M. Bazett-Jones ◽  
Christopher D. Ingersoll ◽  
Grant E. Norte
Keyword(s):  
Electrical Stimulation ◽  
Clinical Practice ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Athletic Trainers ◽  
Neuromuscular Electrical Stimulation ◽  
Current Evidence ◽  
Electrical Nerve Stimulation ◽  
Muscle Inhibition ◽  
Arthrogenic Muscle Inhibition

Context: Arthrogenic muscle inhibition (AMI) is a common neurophysiological response to joint injury. While athletic trainers (ATs) are constantly treating patients with AMI, it is unclear how clinicians are using the available evidence to treat the condition. Objective: To investigate ATs’ general knowledge, clinical practice, and barriers for treating AMI. Methods: A cross-sectional web-based survey was utilized. The survey was distributed to a random sample of 3000 ATs from the National Athletic Trainers’ Association and through social media. 143 board certified ATs (age: 34.6 [10.3] y; experience: 11.7 [9.8] y) from various clinical settings and educational backgrounds were included in the analysis. Results: One hundred one respondents were able to correctly identify the definition of AMI. The majority of these respondents correctly reported that joint effusion (n = 95, 94.1%) and abnormal activity from joint receptors (n = 91, 90.1%) resulted in AMI. Of the 101 respondents, only 58 (57.4%) reported using disinhibitory interventions to treat AMI. The most frequently used evidence supported interventions were transcutaneous electrical nerve stimulation (n = 38, 65.5%), neuromuscular electrical stimulation (n = 33, 56.9%), and focal joint cooling (n = 25, 43.1%). The interventions used correctly most often based on current evidence were neuromuscular electrical stimulation (n = 29/33, 87.9%) and transcutaneous electrical nerve stimulation (n = 26/38, 68.4%). Overall, difficulty quantifying AMI (n = 62, 61.24%) and lack of education (n = 71, 76.2%) were most frequently perceived as barriers. Respondents that did not use disinhibitory interventions perceived lack of experience treating AMI, understanding the terminology, and access to therapeutic modalities more often than the respondents that reported using disinhibitory interventions. Conclusion: Further education about concepts and treatment about AMI is warranted for ATs. Continued understanding of ATs’ clinical practice in regard to AMI may help identify gaps in athletic training clinical education.

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