Author Response Kathleen A. Sluka, Jan M. Bjordal, Serge Marchand and Barbara A. Rakel PHYS THER. 2013; 93:1427-1428. doi: 10.2522/ptj.2013.93.10.1427
The online version of this article, along with updated information and services, can be found online at: http://ptjournal.apta.org/content/93/10/1427 Collections
This article, along with others on similar topics, appears in the following collection(s): Electrotherapy Evidence-Based Practice Pain
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Letters to the Editor Kayla Bergeron-Vezina, Guillaume Leonard
Author Response
K. Bergeron-Vezina, BSc, Research Center on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada.
[Editor’s note: Both the letter to the editor by Bergeron-Vezina and Leonard and the response by Sluka and colleagues are commenting on the page proof version of the article that was published ahead of print on July 11, 2013.]
G. Leonard, PT, PhD, Research Center on Aging, University of Sherbrooke, 1036, Belvedere Sud, Sherbrooke, Quebec, Canada J1H 4C4. Address all correspondence to Dr Leonard at: guillaume.leonard2@ usherbrooke.ca. This letter was posted as a Rapid Response on July 25, 2013 at ptjournal.apta.org.
References 1 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. Phys Ther. 2013;93:1397–1402. 2 Marchand S, Li J, Charest J. Effects of caffeine on analgesia from transcutaneous electrical nerve stimulation. N Engl J Med. 1995;333:325–326. 3 McPartland JM, Mitchell JA. Caffeine and chronic back pain. Arch Phys Med Rehabil. 1997;78:61–63. 4 Benowitz NL. Clinical pharmacology of caffeine. Annu Rev Med. 1990;41:277–288. 5 Sluka KA, Walsh D. Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. J Pain. 2003;4:109–121. 6 Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967;155:108–109. 7 Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. 3rd ed. St Louis, MO: Saunders Elsevier; 2009:457. 8 Benedetti F, Amanzio M, Casadio C, et al. Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg. 1997;63:773–776. 9 Leonard G, Goffaux P, Marchand S. Deciphering the role of endogenous opioids in high-frequency TENS using low and high doses of naloxone. Pain. 2010;151:215–219. 10 Leonard G, Lafrenaye S, Goffaux P. Randomized placebo-controlled cross-over designs in clinical trials: a gold standard to be reassessed. Curr Med Res Opin. 2012;28:245–248. [DOI: 10.2522/ptj.2013.93.10.1426]
October 2013
We thank Bergeron-Vezina and Leonard for their thoughtful comments1 on our article.2 They have brought up important additional and potentially confounding factors that can affect the efficacy of transcutaneous electrical nerve stimulation (TENS). Interactions with drugs such as caffeine—or, as we point out, with opioids—is an area that needs additional study. For example, noradrenergic agonists, such as clonidine, are synergistic with opioid agonists,3 and preclinical studies show synergism with TENS.4 On the other hand, low-frequency TENS also uses serotonin to produce its analgesic effects,5 and use of low-frequency TENS in patients who are on reuptake inhibitors might improve analgesic effectiveness. Thus, understanding the known mechanisms of action of TENS will help to determine whether some drugs interfere with, or whether others can enhance, the efficacy of TENS. Electrode placement is indeed important and is greatly understudied. There are many ways to place electrodes, including over nerves, in dermatomes, at acupoint sites, and surrounding the area of pain. Basic science studies show the greatest effect of TENS on reducing the activity of spinally located pain transmission neurons when the electrodes are placed within the receptive field.6 Preclinical studies also show that placement of electrodes over areas of pain, regardless of whether
they were the originating site or a referred site, is equally effective.7 For human control participants who are healthy, the greatest analgesia typically occurs within the paresthesia site.8 Together, these data suggest and further support Bergeron-Vezina and Leonard’s suggestion that the greatest effects of TENS occur when the sensation of paresthesia covers the painful region. We appreciate the comments about translation of these findings to physical therapist practice and agree that for TENS to be adequately and effectively used in the clinic, numerous factors outlined by us and by Bergeron-Vezina and Leonard should be considered. Kathleen A. Sluka, Jan M. Bjordal, Serge Marchand, Barbara A. Rakel K.A. Sluka, PT, PhD, FAPTA, Department of Physical Therapy and Rehabilitation Science, College of Medicine, College of Nursing, Pain Research Program, University of Iowa, 100 Medical Education Bldg, #1-252, Iowa City, IA 52242 (USA). Address all correspondence to Dr Sluka at: [email protected]. J.M. Bjordal, PT, PhD, Physical Therapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway, and Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway. S. Marchand, PhD, Departement de Chirurgie, Centre de Rechercheclinique Etienne-Le Bel du CHUS, Universite de Sherbrooke, Quebec, Canada. B.A. Rakel, RN, PhD, Department of Physical Therapy and Rehabilitation Science, College of Medicine, College of Nursing, Pain Research Program, University of Iowa. This letter was posted as a Rapid Response on August 23, 2013 at ptjournal.apta.org.
References 1 Bergeron-Vezina K, Leonard G. On “What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature.” Phys Ther. 2013;93:1426–1427.
Volume 93 Number 10 Physical Therapy ■ 1427 Downloaded from http://ptjournal.apta.org/ by Mizue Taniguchi on June 8, 2015
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8/30/13 12:34 PM
Letters to the Editor 2 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. Phys Ther. 2013;93:1397–1402. 3 Fairbanks CA, Posthumus IJ, Kitto KF, et al. Moxonidine, a selective imidazoline/ alpha(2) adrenergic receptor agonist, synergizes with morphine and deltorphin II to inhibit substance P-induced behavior in mice. Pain. 2000;84:13–20. 4 Sluka KA, Chandran P. Enhanced reduction in hyperalgesia by combined administration of clonidine and transcutaneous electrical nerve stimulation. Pain. 2002;100:183–190.
5 Sluka KA, Lisi TL, Westlund KN. Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electrical nerve stimulation in rats with joint inflammation. Arch Phys Med Rehabil. 2006;87:1137–1140.
8 Cowan S, McKenna J, Crum-Gardner E, et al. An investigation of the hypoalgesic effects of TENS delivered by a glove electrode. J Pain. 2009;10:694–701. [DOI: 10.2522/ptj.2013.93.10.1427]
6 Lee KH, Chung JM, Willis WD Jr. Inhibition of primate spinothalamic tract cells by TENS. J Neurosurg. 1985;62:276–287. 7 Ainsworth L, Budelier K, Clinesmith M, et al. Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation. Pain. 2006;120:182–187.
1428 ■ Physical Therapy Volume 93 Number 10
October 2013
Downloaded from http://ptjournal.apta.org/ by Mizue Taniguchi on June 8, 2015
Letter 10.13.indd 1428
8/30/13 12:34 PM
Author Response Kathleen A. Sluka, Jan M. Bjordal, Serge Marchand and Barbara A. Rakel PHYS THER. 2013; 93:1427-1428. doi: 10.2522/ptj.2013.93.10.1427
References
This article cites 8 articles, 2 of which you can access for free at: http://ptjournal.apta.org/content/93/10/1427#BIBL
Subscription Information
http://ptjournal.apta.org/subscriptions/
Permissions and Reprints http://ptjournal.apta.org/site/misc/terms.xhtml Information for Authors
http://ptjournal.apta.org/site/misc/ifora.xhtml
Downloaded from http://ptjournal.apta.org/ by Mizue Taniguchi on June 8, 2015
The online version of this article, along with updated information and services, can be found online at: http://ptjournal.apta.org/content/93/10/1427 Collections
This article, along with others on similar topics, appears in the following collection(s): Electrotherapy Evidence-Based Practice Pain
e-Letters
To submit an e-Letter on this article, click here or click on "Submit a response" in the right-hand menu under "Responses" in the online version of this article.
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Downloaded from http://ptjournal.apta.org/ by Mizue Taniguchi on June 8, 2015
Letters to the Editor Kayla Bergeron-Vezina, Guillaume Leonard
Author Response
K. Bergeron-Vezina, BSc, Research Center on Aging, University of Sherbrooke, Sherbrooke, Quebec, Canada.
[Editor’s note: Both the letter to the editor by Bergeron-Vezina and Leonard and the response by Sluka and colleagues are commenting on the page proof version of the article that was published ahead of print on July 11, 2013.]
G. Leonard, PT, PhD, Research Center on Aging, University of Sherbrooke, 1036, Belvedere Sud, Sherbrooke, Quebec, Canada J1H 4C4. Address all correspondence to Dr Leonard at: guillaume.leonard2@ usherbrooke.ca. This letter was posted as a Rapid Response on July 25, 2013 at ptjournal.apta.org.
References 1 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. Phys Ther. 2013;93:1397–1402. 2 Marchand S, Li J, Charest J. Effects of caffeine on analgesia from transcutaneous electrical nerve stimulation. N Engl J Med. 1995;333:325–326. 3 McPartland JM, Mitchell JA. Caffeine and chronic back pain. Arch Phys Med Rehabil. 1997;78:61–63. 4 Benowitz NL. Clinical pharmacology of caffeine. Annu Rev Med. 1990;41:277–288. 5 Sluka KA, Walsh D. Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. J Pain. 2003;4:109–121. 6 Wall PD, Sweet WH. Temporary abolition of pain in man. Science. 1967;155:108–109. 7 Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. 3rd ed. St Louis, MO: Saunders Elsevier; 2009:457. 8 Benedetti F, Amanzio M, Casadio C, et al. Control of postoperative pain by transcutaneous electrical nerve stimulation after thoracic operations. Ann Thorac Surg. 1997;63:773–776. 9 Leonard G, Goffaux P, Marchand S. Deciphering the role of endogenous opioids in high-frequency TENS using low and high doses of naloxone. Pain. 2010;151:215–219. 10 Leonard G, Lafrenaye S, Goffaux P. Randomized placebo-controlled cross-over designs in clinical trials: a gold standard to be reassessed. Curr Med Res Opin. 2012;28:245–248. [DOI: 10.2522/ptj.2013.93.10.1426]
October 2013
We thank Bergeron-Vezina and Leonard for their thoughtful comments1 on our article.2 They have brought up important additional and potentially confounding factors that can affect the efficacy of transcutaneous electrical nerve stimulation (TENS). Interactions with drugs such as caffeine—or, as we point out, with opioids—is an area that needs additional study. For example, noradrenergic agonists, such as clonidine, are synergistic with opioid agonists,3 and preclinical studies show synergism with TENS.4 On the other hand, low-frequency TENS also uses serotonin to produce its analgesic effects,5 and use of low-frequency TENS in patients who are on reuptake inhibitors might improve analgesic effectiveness. Thus, understanding the known mechanisms of action of TENS will help to determine whether some drugs interfere with, or whether others can enhance, the efficacy of TENS. Electrode placement is indeed important and is greatly understudied. There are many ways to place electrodes, including over nerves, in dermatomes, at acupoint sites, and surrounding the area of pain. Basic science studies show the greatest effect of TENS on reducing the activity of spinally located pain transmission neurons when the electrodes are placed within the receptive field.6 Preclinical studies also show that placement of electrodes over areas of pain, regardless of whether
they were the originating site or a referred site, is equally effective.7 For human control participants who are healthy, the greatest analgesia typically occurs within the paresthesia site.8 Together, these data suggest and further support Bergeron-Vezina and Leonard’s suggestion that the greatest effects of TENS occur when the sensation of paresthesia covers the painful region. We appreciate the comments about translation of these findings to physical therapist practice and agree that for TENS to be adequately and effectively used in the clinic, numerous factors outlined by us and by Bergeron-Vezina and Leonard should be considered. Kathleen A. Sluka, Jan M. Bjordal, Serge Marchand, Barbara A. Rakel K.A. Sluka, PT, PhD, FAPTA, Department of Physical Therapy and Rehabilitation Science, College of Medicine, College of Nursing, Pain Research Program, University of Iowa, 100 Medical Education Bldg, #1-252, Iowa City, IA 52242 (USA). Address all correspondence to Dr Sluka at: [email protected]. J.M. Bjordal, PT, PhD, Physical Therapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway, and Centre for Evidence-Based Practice, Bergen University College, Bergen, Norway. S. Marchand, PhD, Departement de Chirurgie, Centre de Rechercheclinique Etienne-Le Bel du CHUS, Universite de Sherbrooke, Quebec, Canada. B.A. Rakel, RN, PhD, Department of Physical Therapy and Rehabilitation Science, College of Medicine, College of Nursing, Pain Research Program, University of Iowa. This letter was posted as a Rapid Response on August 23, 2013 at ptjournal.apta.org.
References 1 Bergeron-Vezina K, Leonard G. On “What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature.” Phys Ther. 2013;93:1426–1427.
Volume 93 Number 10 Physical Therapy ■ 1427 Downloaded from http://ptjournal.apta.org/ by Mizue Taniguchi on June 8, 2015
Letter 10.13.indd 1427
8/30/13 12:34 PM
Letters to the Editor 2 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. Phys Ther. 2013;93:1397–1402. 3 Fairbanks CA, Posthumus IJ, Kitto KF, et al. Moxonidine, a selective imidazoline/ alpha(2) adrenergic receptor agonist, synergizes with morphine and deltorphin II to inhibit substance P-induced behavior in mice. Pain. 2000;84:13–20. 4 Sluka KA, Chandran P. Enhanced reduction in hyperalgesia by combined administration of clonidine and transcutaneous electrical nerve stimulation. Pain. 2002;100:183–190.
5 Sluka KA, Lisi TL, Westlund KN. Increased release of serotonin in the spinal cord during low, but not high, frequency transcutaneous electrical nerve stimulation in rats with joint inflammation. Arch Phys Med Rehabil. 2006;87:1137–1140.
8 Cowan S, McKenna J, Crum-Gardner E, et al. An investigation of the hypoalgesic effects of TENS delivered by a glove electrode. J Pain. 2009;10:694–701. [DOI: 10.2522/ptj.2013.93.10.1427]
6 Lee KH, Chung JM, Willis WD Jr. Inhibition of primate spinothalamic tract cells by TENS. J Neurosurg. 1985;62:276–287. 7 Ainsworth L, Budelier K, Clinesmith M, et al. Transcutaneous electrical nerve stimulation (TENS) reduces chronic hyperalgesia induced by muscle inflammation. Pain. 2006;120:182–187.
1428 ■ Physical Therapy Volume 93 Number 10
October 2013
Downloaded from http://ptjournal.apta.org/ by Mizue Taniguchi on June 8, 2015
Letter 10.13.indd 1428
8/30/13 12:34 PM
Author Response Kathleen A. Sluka, Jan M. Bjordal, Serge Marchand and Barbara A. Rakel PHYS THER. 2013; 93:1427-1428. doi: 10.2522/ptj.2013.93.10.1427
References
This article cites 8 articles, 2 of which you can access for free at: http://ptjournal.apta.org/content/93/10/1427#BIBL
Subscription Information
http://ptjournal.apta.org/subscriptions/
Permissions and Reprints http://ptjournal.apta.org/site/misc/terms.xhtml Information for Authors
http://ptjournal.apta.org/site/misc/ifora.xhtml
Downloaded from http://ptjournal.apta.org/ by Mizue Taniguchi on June 8, 2015
