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Leeds, United Kingdom

Moran F.,University of Ulster | Leonard T.,University of Ulster | Hawthorne S.,University of Ulster | Hughes C.M.,University of Ulster | And 6 more authors.
Journal of Pain | Year: 2011

Transcutaneous electrical nerve stimulation (TENS) is an electrophysical modality used for pain management. This study investigated the dose response of different TENS intensities on experimentally induced pressure pain. One hundred and thirty TENS naïve healthy individuals (18-64 years old; 65 males, 65 females) were randomly allocated to 5 groups (n = 26 per group): Strong Non Painful TENS; Sensory Threshold TENS; Below Sensory Threshold TENS; No Current Placebo TENS; and Transient Placebo TENS. Active TENS (80 Hz) was applied to the forearm for 30 minutes. Transient Placebo TENS was applied for 42 seconds after which the current amplitude automatically reset to 0 mA. Pressure pain thresholds (PPT) were recorded from 2 points on the hand and forearm before and after TENS to measure hypoalgesia. There were significant differences between groups at both the hand and forearm (ANOVA; P =.005 and.002). At 30 minutes, there was a significant hypoalgesic effect in the Strong Non Painful TENS group compared to: Below Sensory Threshold TENS, No Current Placebo TENS and Transient Placebo TENS groups (P <.0001) at the forearm; Transient Placebo TENS and No Current Placebo TENS groups at the hand (P =.001). There was no significant difference between Strong Non Painful TENS and Sensory Threshold TENS groups. The area under the curve for the changes in PPT significantly correlated with the current amplitude (r 2 =.33, P =.003). These data therefore show that there is a dose-response effect of TENS with the largest effect occurring with the highest current amplitudes. Perspective: This study shows a dose response for the intensity of TENS for pain relief with the strongest intensities showing the greatest effect; thus, we suggest that TENS intensity should be titrated to achieve the strongest possible intensity to achieve maximum pain relief. © 2011 by the American Pain Society. Source

Kolen A.F.,HIGH-TECH | De Nijs R.N.J.,Elkerliek Hospital | Wagemakers F.M.,HIGH-TECH | Meier A.J.L.,Maxima Medical Center | And 2 more authors.
Pain | Year: 2012

A novel device was developed that measured local electrical skin resistance and generated pulsed local electrical currents that were delivered across the skin around the knee for patients with osteoarthritis (termed eBrace TENS). Currents were delivered using an electrode array of 16 small circular electrode elements so that stimulation could be spatially targeted. The aim of this study was to investigate the effects of spatially targeted transcutaneous electrical nerve stimulation (TENS) to points of low skin resistance on pain relief and mobility in osteoarthritis of the knee (OAK). A randomised, controlled, 3-arm, parallel-group trial was designed that compared pain and function following a 30 to 45 minute intervention of TENS at specific locations depending on the local electrical skin resistance. Pain intensity by the visual analogue scale (VAS), 6-minute walk test, maximum voluntary contraction (MVC), and range-of-motion (ROM) were the primary outcomes. Lowest-resistance TENS reduced pain intensity during walking relative to resting baseline compared with random TENS (95% confidence interval of the difference: -20.8 mm, -1.26 mm). There were no statistically significant differences between groups in distance during the walk test, maximum voluntary contraction (MVC) or range-of-motion (ROM) measures or WOMAC scores. In conclusion, we provide evidence that use of a matrix electrode that spatially targets strong nonpainful TENS for 30 to 45 minutes at sites of low resistance can reduce pain intensity at rest and during walking. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. Source

Johnson M.I.,Leeds Beckett University | Johnson M.I.,Leeds Pallium Research Group | Bjordal J.M.,Bergen University College | Bjordal J.M.,University of Bergen
Expert Review of Neurotherapeutics | Year: 2011

The management of neuropathic pain is challenging, with medication being the first-line treatment. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is used as an adjunct to medication. Clinical experience suggests that TENS is beneficial providing it is administered at a sufficiently strong intensity, close to the site of pain. At present, there are too few randomized controlled trials on TENS for neuropathic pain to judge effectiveness. The findings of systematic reviews of TENS for other pain syndromes are inconclusive because trials have a low fidelity associated with inadequate TENS technique and infrequent treatments of insufficient duration. The use of electrode arrays to spatially target stimulation more precisely may improve the efficacy of TENS in the future. © 2011 Expert Reviews Ltd. Source

Johnson M.I.,Leeds Beckett University | Johnson M.I.,Leeds Pallium Research Group | Gohil M.,Leeds Beckett University
Scandinavian Journal of Pain | Year: 2016

Background and aims: Mirror visual feedback may be a useful clinical tool for reducing pain. Research suggests that reducing the size of a non-painful reflected hand can alleviate complex regional pain syndrome in the affected hand that is out of view. In contrast, research on healthy humans exposed to experimentally induced pain suggests that reducing the appearance of the size of a reflected body part can increase pain. The aim of this study was to investigate the effect of enlarging and reducing the visual appearance of the size of a hand using mirror visual feedback on pain threshold, intensity and tolerance in healthy human participants exposed to cold-pressor pain. Methods: Participants were a convenience sample of 20 unpaid, healthy pain free volunteers aged 18 years or above. Each participant took part in one experiment where they completed cold-pressor pain tests whilst observing normal, enlarged and reduced size reflections of a hand congruent to a hand immersed in the ice cold water. A 4. ×. 2 factorial repeated measures analysis of variance (ANOVA) was performed on time to pain threshold and pain tolerance, and pain intensity with Condition (four levels: no reflection, reduced reflection, normal reflection, enlarged reflection) being the within-subject factors and Sex (two levels: female, male) between-subject factors. Results: There were no significant effects for Condition, Sex, or Condition. ×. Sex interaction for pain threshold, intensity or tolerance (p> 0.05). There were no significant differences between the 3 mirror reflection conditions for agreement with the statements: "It felt like I was looking directly at my hand rather than at a mirror image"; "It felt like the hand I was looking at was my hand"; and "Did it seem like the hand you saw was a right hand or a left hand?". Conclusion: Enlarging or reducing the size of a hand using mirror visual feedback did not alter pain perception in healthy human participants exposed to cold-pressor pain. The different sizes of hands generated by mirror visual feedback created an illusion of looking at their own hand but this was not as strong as looking directly at the hand. Implications: In future, investigators and clinicians using mirror visual feedback may consider including an adaptive phase to ensure the reflection has been perceptually embodied. Reasons for the lack of effects are explored to inspire further research in the field. © 2015 Scandinavian Association for the Study of Pain. Source

Konopinski M.D.,Leeds Beckett University | Jones G.J.,Leeds Beckett University | Johnson M.I.,Leeds Beckett University | Johnson M.I.,Leeds Pallium Research Group
American Journal of Sports Medicine | Year: 2012

Background: A recent meta-analysis found that generalized joint hypermobility is a risk factor for knee injuries during contact sports. The effect of hypermobility on the incidence of injuries in elite-level professional soccer players is not known.Purpose: To compare the incidence of injury between hypermobile and nonhypermobile elite-level male professional soccer players.Study Design: Cohort study; Level of evidence, 2.Methods: Fifty-four players from an English Premier League soccer club were assessed for hypermobility, using the 9-point Beighton scale (threshold, 4 points or above), at the start of the 2009-2010 season. Time-loss injuries and individual exposure times were recorded during all club training sessions and matches throughout the entire season.Results: Mean ± standard deviation incidence of injuries was 11.52 ± 11.39 injuries/1000 h, and the prevalence of hypermobility was 33.3% (18 of 54 players). There were 133 injuries during 13 897.5 hours of exposure. During the season, hypermobile participants had a higher incidence of injuries (mean [95% confidence interval] difference, 15.65 [9.18-22.13] injuries/1000 h; P =.001) and were more likely to experience at least 1 injury, a reinjury, and a severe injury compared with nonhypermobile participants. There were 9 severe knee injuries in hypermobile participants, of which 6 were cartilage injuries.Conclusion: There was an increased incidence of injury in hypermobile elite-level professional soccer players from an English Premier League club, resulting in more missed days from training and match play. These findings suggest a need for routine screening for hypermobility in professional soccer. © 2012 The Author(s). Source

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