Pain Shield: Research Abstracts

A few days ago, one of our members reminded me that he's been looking for information on a form of nerve stimulation device called "Pain Shield". I sent a note to a neurosurgeon and got back the following information...

Regards, Red

This is not a new approach, first utilized in 1987 for wound pain.

It is now widely used, but as the last review analysis suggests the results are largely anecdotal-one patient one time, sometimes not the same result i the same person the next time.

It is quite cumbersome, but ultimately not harmful.

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Am J Emerg Med. 1987 Jan;5(1):6-10.

Transcutaneous electrical nerve stimulation versus oral analgesic: a randomized double-blind controlled study in acute traumatic pain.

Ordog GJ.

Abstract

A double-blind controlled analgesic study was undertaken in outpatients suffering acute traumatic pain. One hundred patients completed the study and were randomly assigned to four treatment groups, each receiving either functioning transcutaneous electrical nerve stimulators (TENS), placebo TENS, acetaminophen with codeine and a functioning TENS, or acetaminophen with codeine and a placebo TENS. Pain was assessed prior to treatment, at 48 hours, and at one month using a visual analog scale. A statistically significant difference in pain relief occurred between the placebo and functioning TENS groups. The TENS was approximately as effective as acetaminophen (300-600 mg) with codeine (30-60 mg) but had no side effects. Transcutaneous electrical nerve stimulators have been shown to be effective in the management of acute traumatic pain and may be indicated for patients who cannot be given medications.

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Anesth Analg. 2010 Nov;111(5):1301-7. Epub 2010 Jun 8.

The analgesic and antihyperalgesic effects of transcranial electrostimulation with combined direct and alternating current in healthy volunteers.

Nekhendzy V, Lemmens HJ, Tingle M, Nekhendzy M, Angst MS.

Source Stanford University, Department of Anesthesia, Stanford, CA, USA. ■■■■■■■■■■■■■■■■

Abstract

BACKGROUND: Transcranial electrostimulation (TES) has been reported to produce clinically significant analgesia, but randomized and double-blind studies are lacking. We investigated the analgesic and antihyperalgesic effects of TES in validated human experimental pain models.

METHODS: In 20 healthy male subjects we evaluated the analgesic and antihyperalgesic effects of TES(60Hz) and TES(100Hz) to heat and mechanical pain in experimentally induced ultraviolet B skin sunburns and in normal skin. Previous animal studies in our laboratory predicted that TES(60Hz) would provide significant analgesia, and TES(100Hz) was a suitable active control. The study was conducted in a double-blind, randomized, 2-way cross-over fashion. TES was administered for 35 minutes. Quantitative sensory testing evaluating heat and mechanical pain thresholds was conducted before TES, during TES, and 45 minutes after TES.

RESULTS: TES (TES(60Hz) > TES(100Hz)) evoked rapidly developing, significant thermal and mechanical antihyperalgesic effects in the ultraviolet B lesion, and attenuated thermal pain in unimpaired skin. No long-lasting analgesic and antihyperalgesic effects of a single TES treatment were demonstrated in this study.

CONCLUSIONS: TES produces significant, frequency-dependent antihyperalgesic and analgesic effects in humans. The characteristics of the TES effects indicate a high likelihood of its ability to modulate both peripheral sensitization of nociceptors and central hyperexcitability

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Cochrane Database Syst Rev. 2009 Oct 7;(4):CD004251.

Electrotherapy for neck pain.

Kroeling P, Gross A, Goldsmith CH, Burnie SJ, Haines T, Graham N, Brant A.

Source Dept. of Physical Medicine and Rehabilitation (Director: Prof. Dr. Gerold Stucki), Ludwig-Maximilians-University of Munich, Marchionini-Str. 17, D-81377 München, Germany, D-80801.

Abstract

BACKGROUND: Neck pain is common, disabling and costly. The effectiveness of electrotherapy as a physiotherapeutic option remains unclear. This update replaces our 2005 Cochrane review on this topic.

OBJECTIVES: To assess whether electrotherapy improves pain, disability, patient satisfaction, and global perceived effect in adults with neck pain.

SEARCH STRATEGY: Computer-assisted searches of: CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, without language restrictions, from their beginning to December 2008; handsearched relevant conference proceedings; consulted content experts.

SELECTION CRITERIA: Randomised controlled trials in any language, investigating the effects of electrotherapy, used primarily as unimodal treatment for neck pain. Quasi-RCTs and controlled clinical trials were excluded.

DATA COLLECTION AND ANALYSIS: At least two authors independently conducted citation identification, study selection, data abstraction, and risk of bias assessment. We were unable to statistically pool any of the results, but assessed the quality of the evidence using an adapted GRADE approach.

MAIN RESULTS: Eighteen small trials (1043 people with neck pain) with 23 comparisons were included. Analysis was limited by trials of varied quality, heterogeneous treatment subtypes and conflicting results. The main findings for reduction of neck pain by treatment with electrotherapeutic modalities are:Very low quality evidence that pulsed electromagnetic field therapy (PEMF), repetitive magnetic stimulation (rMS) and transcutaneous electrical nerve stimulation (TENS) are more effective than placebo.Low quality evidence that permanent magnets (necklace) are not more effective than placebo.Very low quality evidence that modulated galvanic current, iontophoresis and electric muscle stimulation (EMS) are not more effective than placebo.There were only four trials that reported on other outcomes such as function and global perceived effects, but none were of clinical importance.

AUTHORS' CONCLUSIONS: We cannot make any definite statements on the efficacy and clinical usefulness of electrotherapy modalities for neck pain. Since the quality of evidence is low or very low, we are uncertain about the estimate of the effect. Further research is very likely to change both the estimate of effect and our confidence in the results. Current evidence for PEMF, rMS, and TENS shows that these modalities might be more effective than placebo but not other interventions. Funding bias should be considered, especially in PEMF studies. Galvanic current, iontophoresis, electric muscle stimulation(EMS), and static magnetic field did not reduce pain or disability. Future trials on these interventions should have larger patient samples and include more precise standardization and description of all treatment characteristics.

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Dear Red ,

as i said - the doctor who developed this device in it's form , Dr Adahan , is from Israel and i've met with him more than a year ago . he is now the head of pain deparment here.

(by the way - the device is not original as you said, it developed from other devices - to be used for TN)

as a person - i didn't like the doctor at all. after the meeting with him - it was the first time i went crying from a doctor. i saw him privetly , costs a lot, and he said my situatuin is Psycological and reffered my to a psyciatrist.

i couldn't belive that a man who should be specilized in TN (or facial pain) wouldn't understand the pain . etc.

he dared to tell me - i don't look suffering like a person with TN . i chill out when i come to think about it now.

BUT-

i have to say in his best - that he was fair - in the term that he could have rented me the device and have me spent money on it - but instead he was honest (from his point of view) and told me it would not fit my situation.

now-

i've talked to two persons from Israel (one is from this site) who tried this device for a few month - and it didn't help them at all.

but - i can accept that there are who this helped them.

and who knows - in our situation we'll try everything (hell, i'm willing even to try healers and "Witchcraft" (don't know the ecect term in english).

the device istelsf published itself as good only for classic TN.

maybe, Red, as you said it works only saporadic - sometimes it does- sometimes not.

i know i was invited to be on the staff of an independent trail-group to try this device for free. but it didn't work out in the end. i may call the one who did the research (it was from Tel Hasomer/Sheba hospital in Israel) and ask them what's going on with that.

Nir, when you tell me that a physician who treats trigeminal neuralgia has rejected you as a patient because he believes your facial pain is "psychological" in origin, my immediate reaction is that you're dealing with an improperly trained doctor -- or one who is simply incompetent. Such reactions to a patient do not argue well for the effectiveness of the device he is selling.

I also think it is a fundamental mistake to invest in witchcraft, Ayurvedic Medicine, sympathetic magic, cervical chiropractic "adjustment" of the atlas, low-inflammation diets or homeopathy. None of these practices is likely to actively harm you (with the possible exception of chiropractic involving sharp movements of the spine). But none of them is likely to help, either, and meantime you can end up thousands of dollars poorer.

Be advised that there are standards for conducting a medical trial. One of the standards is that there should be a practice oversight committee and a published "protocol" which standardize the conduct of the trial and ensure that it is truly randomized/controlled, incorporating methods which detect and evaluate placebo effect. If Tel Hasomer isn't willing to publish its protocol or register its trial with the US National Institutes of Health, then I'd say you are dealing with less than the best in medical institutions.

Regards and best,

Red

hi Red,

yes. its was amazing to me how a doctor who publishes detailed articles about this pain , and what causes it , very dettaied - dismisses me as it was pshcological pain (just like that).

and this from a dr. who makes vidoed in youtube to advertise his product and should known better than anyone else what is to live with facial pain is like .

i do not dismiss the function of mental stress or mental state on pain - but this does not cause this pain. it can increases it etc. not cause it.

i have found it is many times the case - where i see on the web articles from' so-called' proffesionals who write a very impressive and detailed article of the causes for TN or ATN - -such as infection/inflammation/ nerve twisting etc... but when i called them or went to an appiontemnt - i saw that all their knowledge is just theretical . when you go to them - they just say something like "neuropatic pain" etc.

about all the other 'natural" methods. i don't dismiss them.

i DO belive that there are people that accupancture , or chrirpractice or Bowen method or dieting - changed or even saved thier life. you often here of that cousin, or neighbour that tells you that see had to do major surgery - but them she did accupancture - and it saved her from doing a surgery for example.

but the sad thing- is that those miracles always happen to others. not me.

it doesn't mean i won't keep looking in other channels.

all the best,

nir