Transcutaneous spinal electroanalgesia : its efects in healthy volunteers, acute and chronic pain patients

Epidemiological studies have shown that chronic pain is a major public health problem, because of the huge suffering of patients and the enormous medical and social resources required to optimise patient care. Currently there is a lot of interest in non-pharmacological, non-invasive therapies for both acute and chronic pain conditions. Transcutaneous Electrical Nerve Stimulation (TENS), by stimulation of Ab fibres peripherally, interrupts the ascending transmission of painful impulses. However, its effects are known to diminish with time. Furthermore, it is not possible to undertake randomised double-blind trials with TENS, as the patients will always feel the tingling sensation when the machine is switched on. For patients with severe chronic intractable pain, a small device may be implanted around the spinal cord, which also interferes with ascending pain transmission - spinal cord stimulation. However this is a costly, invasive procedure with potentially serious complications. The new non-invasive technique of Transcutaneous Spinal Electroanalgesia (TSE) is thought to simulate the effect of spinal cord stimulation. As patients feel no peripheral stimulation when the device is switched on, all trials were double blinded with sham electrodes.;Postoperatively, TSE did not reduce the incidence of request for postoperative analgesia or the time or first request for analgesia. However, a trend towards lower pain scores was demonstrated. In the three sub groups of chronic pain patients studied, TSE did not bring about a reduction in pain intensity. Furthermore, there were no significant differences in quality of life following active TSE apart from a difference in the social functioning component of the SF-36 questionnaire in patients with chronic lumbar radiculopathy. TSE treatment did not affect thermal sensation, pain or mood in healthy volunteers.;This thesis has failed to demonstrate any effect of TSE treatment in healthy volunteers, in patients postoperatively and patients in the chronic pain clinic.