Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20240015-en
Brazilian Journal of Pain
Original Article

Influence of pain prognosis and electrical stimulation modality on the amplitude of current elicited at sensory threshold in chronic lumbar pain sufferers

Influência do prognóstico para dor e da modalidade de estimulação elétrica na amplitude de corrente elicitada no limiar sensorial em lombálgicos crônicos

Amanda Jakovacz; Lais Panno; Alessandra Linzmeyer; Gladson Ricardo Flor Bertolini; Alberito Rodrigo de Carvalho

Downloads: 0
Views: 72

Abstract

BACKGROUND AND OBJECTIVES: Sensory function may be altered in chronic low back pain (CLBP), which may alter the perception of therapeutic currents. The aim of this study was to verify whether the risk of poor prognosis for CLBP pain influences the amplitude elicited at the sensory threshold (ST) in different modalities of neuromuscular electrical stimulation (NMES).
METHODS: This is a quasi-experimental counterbalanced study with 40 subjects divided into four groups (n=10 each), according to the risk of poor prognosis for pain: no risk (control group - CG), low (LrG), medium (MrG), and high (HrG) risks. Four modalities of NMES were tested: two medium frequency currents (Aussie current [AC] and Russian current [RC]) and two low frequency currents (commonly known as functional electrical stimulation [FES]), with two phase durations of200 μs (FES_200) and 500 μs (FES_500), in the region of the lumbar multifidus muscles. All subjects were exposed to all current modalities with interval periods, and when the ST was reached, the amplitude of the current measured in mA was recorded.
RESULTS: The currents that elicited the highest and lowest amplitude in the ST were FES_200 and AC, respectively. As for the risk of poor prognosis, the highest amplitudes were for the HrG and the lowest for the LrG.
CONCLUSION: The amplitude of the current elicited in the ST tended to be higher among those with a higher risk of poor prognosis for pain and, among the currents, those of medium frequency elicited lower amplitudes.

Keywords

Electrical stimulation therapy, Low back pain, Psychosocial impact

Resumo

JUSTIFICATIVA E OBJETIVOS: A função sensorial é potencialmente alterada na presença de dor lombar crônica (DLC), o que pode alterar a percepção de passagem de correntes terapêuticas. O objetivo deste estudo foi verificar se o risco de mau prognóstico para DLC influencia a amplitude elicitada no limiar sensorial (LS) em diferentes modalidades de estimulação elétrica neuromuscular (EENM). 
MÉTODOS: Trata-se de um estudo quase-experimental contrabalanceado composto por 40 voluntários alocados em quatro grupos (n=10 cada), de acordo com o risco de mau prognóstico para dor: sem risco (grupo controle – GC), baixo risco (GBR), médio risco (GMR) e alto risco (GAR). Foram testadas quatro modalidades de EENM: duas correntes de média frequência (corrente Aussie [CA] e corrente Russa [CR]) e duas correntes de baixa frequência (comumente denominada estimulação elétrica funcional [FES]), com duas durações de fases 200 µs (FES_200) e 500 µs (FES_500) na região dos músculos multífidos lombares. Todos os voluntários foram submetidos a todas as modalidades de corrente, com períodos de intervalos, e ao ser atingido o LS, foi realizado o registro da amplitude da corrente medida em mA. 
RESULTADOS: As correntes que elicitaram a maior e a menor amplitude no LS foram, respectivamente, FES_200 e CA. Quanto ao risco de mau prognóstico, as maiores amplitudes foram do GAR e as menores do GBR. 
CONCLUSÃO: A amplitude da corrente elicitada no LS tendeu a ser mais alta entre aqueles com maior risco de mau prognóstico para dor e, dentre as correntes, aquelas de média frequência elicitaram amplitudes mais baixas.

Palavras-chave

Dor lombar, Impacto psicossocial, Terapia por estimulação elétrica

References

1 Darlow B, Perry M, Dean S, Mathieson F, Baxter GD, Dowell A. Putting physical activity while experiencing low back pain in context: balancing the risks and benefits. Arch Phys Med Rehabil. 2016;97(2):245-251.e7.

2 Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJEM, Ostelo RWJG, Guzman J, van MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ. 2015;350:h444.

3 Knezevic NN, Candido KD, Vlaeyen JWS, van Zundert J, Cohen SP. Low back pain. Lancet. 2021;398(10294):78-92.

4 Pilz B, Vasconcelos RA, Teixeira PP, Mello W, Marcondes FB, Hill JC, Grossi DB. Construct and discriminant validity of STarT Back Screening Tool - Brazilian version. Braz J Phys Ther. 2017;21(1):69-73.

5 Pilz B, Vasconcelos RA, Marcondes FB, Lodovichi SS, Mello W, Grossi DB. The Brazilian version of STarT Back Screening Tool - translation, cross-cultural adaptation and reliability. Braz J Phys Ther. 2014;18(5):453-61.

6 Sponbeck JK, Moody MA, Mitchell UH, Neves CD, Johnson AW. Multifidus muscle cross-sectional area adaptations over two volleyball seasons and one off-season in athletes with and without low back pain. J Back Musculoskelet Rehabil. 2022;35(5):1135-42.

7 Sions JM, Crippen DC, Hicks GE, Alroumi AM, Manal TJ, Pohlig RT. Exploring neuromuscular electrical stimulation intensity effects on multifidus muscle activity in adults with chronic low back pain: an ultrasound imaging-informed investigation. Clin Med Insights Arthritis Musculoskelet Disord. 2019;12:1179544119849570.

8 Russo M, Deckers K, Eldabe S, Kiesel K, Gilligan C, Vieceli J, Crosby P. Muscle control and non-specific chronic low back pain. Neuromodulation. 2018;21(1):1-9

9 Sonnery-Cottet B, Saithna A, Quelard B, Daggett M, Borade A, Ouanezar H, Thaunat M, Blakeney WG. Arthrogenic muscle inhibition after ACL reconstruction: a scoping review of the efficacy of interventions. Br J Sports Med. 2019;53(5):289-98.

10 Goubert D, van Oosterwijck J, Meeus M, DanneeST L. Structural changes of lumbar muscles in non-specific low back pain: a systematic review. Pain Physician. 2016;19:E985-1000.

11 Ogon I, Takebayashi T, Takashima H, Morita T, Yoshimoto M, Terashima Y, Yamashita T. Quantitative analysis concerning atrophy and fat infiltration of the multifidus muscle with magnetic resonance spectroscopy in chronic low back pain. Spine Surg Relat Res. 2018;3(2):163-70.

12 Maffiuletti NA, Green DA, Vaz MA, Dirks ML. Neuromuscular electrical stimulation as a potential countermeasure for skeletal muscle atrophy and weakness during human spaceflight. Front Physiol. 2019;10:1-8.

13 Kocamaz D, Yakut H, Özberk S. Patients’ satisfaction with and awareness of electrical stimulation therapy. Physiother Q. 2020;28(1):11-5.

14 Pereira KE, Pereira KL, Stachelski RA, Buzanello Azevedo MR, Carvalho AR, Flor Bertolini GR. KiloHertz currents on aspects of muscle function: A scoping review. J Bodyw Mov Ther. 2022;32:110-19.

15 Linzmeyer A, Coracini CA, Bertolini GR, Carvalho AR. Efeito da estimulação elétrica neuromuscular na função muscular em pacientes com dor lombar crônica: revisão sistemática. BrJP. 2022;5(2):161-7.

16 Lefaucheur JP, Abbas SA, Lefaucheur-Ménard I, Rouie D, Tebbal D, Bismuth J, Nordine T. Small nerve fiber selectivity of laser and intraepidermal electrical stimulation: A comparative study between glabrous and hairy skin. Neurophysiol Clin. 2021;51(4):357-74.

17 Batistella CE, Bidin F, Giacomelli I, Nunez MA, Gasoto E, Albuquerque CE, Flores LJF, Bertolini GRF. Effects of the Russian current in the treatment of low back pain in women: a randomized clinical trial. J Bodyw Mov Ther. 2020;24(2):118-22.

18 Cittadin GL, Ansolin GZ, Furtado Santana NP, Tonini TL, Buzanello Azevedo MR, de Albuquerque CE, Flor Bertolini GR. Comparison between Russian and Aussie currents in the grip strength and thickness muscles of the non-dominant hand: a double-blind, prospective, randomized-controlled study. Turk J Phys Med Rehabil. 2020;66(4):423-8.

19 Silva BC, Coracini CA, Branco CL, Michelon MD, Bertolini GR. Corrente Aussie em estudantes com cervicalgia crônica: um ensaio clínico randomizado. BrJP 2018;1(3):202-6.

20 Maffiuletti NA, Gondin J, Place N, Stevens-Lapsley J, Vivodtzev I, Minetto MA. Clinical use of neuromuscular electrical stimulation for neuromuscular rehabilitation: what are we overlooking? Arch Phys Med Rehabil. 2018;99(4):806-12.

21 De Oliveira PFA, Durigan JLQ, Modesto KAG, Bottaro M, Babault N. Neuromuscular fatigue after low- and medium-frequency electrical stimulation in healthy adults. Muscle Nerve. 2018;58(2):293-9.

22 Mukaino M, Ono T, Shindo K, Fujiwara T, Ota T, Kimura A, Liu M, Ushiba J. Efficacy of brain-computer interface-driven neuromuscular electrical stimulation for chronic paresis after stroke. J Rehabil Med. 2014;46(4):378-82.

23 Mettler JA, Bennett SM, Doucet BM, Magee DM. Neuromuscular electrical stimulation and anabolic signaling in patients with stroke. J Stroke Cerebrovasc Dis. 2017;26(12):2954-63.

24 Pelegrini ACA, Gasoto E, Bussolaro JM, Segatti G, Albuquerque CE, Bertolini GRF. The analgesic action of Aussie current in women with non-specific chronic lumbar pain. Int J Ther Rehabil. 2019;26(7):1-10.

25 Lopes AB, Amboni DE, Schmidel MM, Maciel MJ, Carvalho AR, Bertolini GRF. Evaluation of the dose-response for electrostimulation with Aussie current in the core strength. Eur J Clin Exp Med. 2020;18(2):81-7.

26 Embaby EA, ESTayed WH, Ahmed RM, Abdel azeim AS. Comparative effectiveness of Russian current and low-frequency puSTed current in mechanical low back pain. Turkish J Physiother Rehabil. 2021;32(3):12285-94.

27 Cash RFH, Isayama R, Gunraj CA, Ni Z, Chen R. The influence of sensory afferent input on local motor cortical excitatory circuitry in humans. J Physiol. 2015;593(7):1667-84.

28 De Ridder D, Adhia D, Vanneste S. The anatomy of pain and suffering in the brain and its clinical implications. Neurosci Biobehav Rev. 2021;130:125-46.

29 Yeater TD, Clark DJ, Hoyos L, Valdes-Hernandez PA, Peraza JA, Allen KD, Cruz-Almeida Y. Chronic pain is associated with reduced sympathetic nervous system reactivity during simple and complex walking tasks: potential cerebral mechanisms. Chronic Stress. 2021;5:24705470211030273.

30 Galan-Martin MA, Montero-Cuadrado F, Lluch-Girbes E, Coca-López MC, Mayo-Iscar A, Cuesta-Vargas A. Pain neuroscience education and physical therapeutic exercise for patients with chronic spinal pain in spanish physiotherapy primary care: a pragmatic randomized controlled trial. J Clin Med. 2020;9(4):1201.

31 Barros MIG, Suguiura ITR, Linzmeyer A, Carvalho AR. Association between two classification modeST of chronic painful low back disorders, “biomedical” and “biopsychosocial.” Varia Sci - Ciências da Saúde. 2023;9(1):57-63.

32 Nijs J, Lahousse A, Kapreli E, Bilika P, Saraçoglu 1, Malfliet A, Coppieters I, De Baets L, Leysen L, Roose E, Clark J, Voogt L, Huysmans E. Nociplastic pain criteria or recognition of central sensitization? pain phenotyping in the past, present and future. J Clin Med. 2021;10(15):3203.

33 Nijs J, Meeus M, Cagnie B, Roussel NA, Dolphens M, Van Oosterwijck J, Danneels L. A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training. Phys Ther. 2014;94(5):730-8.

34 Nijs J, De Baets L, Hodges P. Phenotyping nociceptive, neuropathic, and nociplastic pain: who, how, and why? Brazilian J Phys Ther. 2023;27(4):100537.

35 Medeiros FC, Salomão EC, Costa LOP, Freitas DG, Fukuda TY, Monteiro RL, Added MAN, Garcia AN, Costa LDCM. Use of the STarT Back Screening Tool in patients with chronic low back pain receiving physical therapy interventions. Braz J Phys Ther. 2021;25(3):286-95.

36 Buldys K, Górnicki T, Kalka D, Szuster E, Biernikiewicz M, Markuszewski L, Sobieszczaήska M. What do we know about nociplastic pain? Healthcare. 2023;11(12):1794.

37 Thivel D, Tremblay A, Genin PM, Panahi S, Rivière D, Duclos M. Physical activity, inactivity, and sedentary behaviors: definitions and implications in occupational health. Front Public Heal. 2018;6(288):1-5.

38 Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91.

39 Flodin J, Juthberg R, Ackermann PW. Effects of electrode size and placement on comfort and efficiency during low-intensity neuromuscular electrical stimulation of quadriceps, hamstrings and gluteal muscles. BMC Sports Sci Med Rehabil. 2022;14(1):11.

40 Lakens D. Calculating and reporting effect sizes to facilitate cumulative science: a practical primer for t-tests and ANOVAs. Front Psychol. 2013;4:863.

41 Sawilowsky SS. New effect size rules of thumb. J Mod Appl Stat Methods. 2009;8(2):597-9.

42 Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895-926.

43 de Goeij M, van Eijk LT, Vanelderen P, Wilder-Smith OH, Vissers KC, van der Hoeven JG, Kox M, Scheffer GJ, Pickkers P. Systemic inflammation decreases pain threshold in humans in vivo. PLoS One. 2013;8(12):e84159.

44 Nagakura Y, Malkmus S, Yaksh TL. Determination of current threshold for paw withdrawal with sine-wave electrical stimulation in rats: effect of drugs and alteration in acute inflammation. Pain. 2008;134(3):293-301.

45 Smart KM, Blake C, Staines A, Doody C. Self-reported pain severity, quality of life, disability, anxiety and depression in patients classified with ‘nociceptive’, ‘peripheral neuropathic’ and ‘central sensitisation’ pain. The discriminant validity of mechanisms-based classifications of low back (±leg) pain. Man Ther. 2012;17(2):119-25.

46 Dionísio GH, Salermo VY, Padilha A. Central sensitization and beliefs among patients with chronic pain in a primary health care unit. Brazilian J Pain. 2020;3(1):42-7.

47 Insausti-Delgado A, López-Larraz E, Omedes J, Ramos-Murguialday A. Intensity and dose of neuromuscular electrical stimulation influence sensorimotor cortical excitability. Front Neurosci. 2021;14:593360.
 


Submitted date:
11/05/2023

Accepted date:
02/02/2024

66608010a953950250017105 brjp Articles

BrJP

Share this page
Page Sections