Impact of Dynamic Electroneurostimulation on Homeostasis in
Treatment of Pain Syndromes
Chernysh I.M., Koroleva M.V., Krasnova L.B., Dubova M.N., Meizerov E.E.
Reflex Therapy Institute of Federal Scientific Clinic-Experimental Center for
Traditional Diagnostic and Treatment Methods of MH of RF, Moscow
Pain is one of the most common symptoms and syndromes that doctor of any
specialty meets with in his/her practice, that is why problem of anesthetization has
a general-medical nature. Modern methods of physiotherapy and reflex therapy,
including transcutaneous electroneurostimulation (TENS), got a wide distribution
in complex treatment of pain syndromes [5]. It is caused by simplicity of
application, noninvasiveness, fair effectiveness of method as well as absence of
toxicity and allergic reactions which makes possible a long-term usage of the
method.
At present group of apparatuses is being developed; parameters of electro
stimulation of these apparatuses change dynamically depending on an impedance
of tissues in the zone of application which significantly raises effectiveness of
treatment due to reduction of adaptation of nerve elements to electrical stimuluses.
This kind of TENS got a name of dynamic electroneurostimulation (DENS) which
is being realized with the help of apparatuses of “DENAS” family. To date
dynamic electroneurostimulation is widely applied among physiotherapy and
reflex therapy methods [11].
We carried out clinical, physiological and biochemical research of
sanogenesis mechanisms at the time of dynamic electroneurostimulation therapy.
The most important homeostasis characteristics that are related to stress
mechanisms, pain and anesthetization were studied [7,8,9,10,14].
Complex examination of 19 patients in the age range 30 to 70 (there were 3
men and 16 women) with pain syndromes of different genesis was carried out: 18
patients had vertebrogenous pain syndromes of cervical, thoracic and lumbar
localization; 8 patients suffered from cephalgia of different genesis (2 patients had
it in the presence of essential hypertension and cerebral atherosclerosis, 6 patients
had it in the presence of vegetovascular dystonia); 3 patients had articular algesic
syndrome (2 patients had Reiter’s syndrome, 1 patient had nonspecific artritis); 2
patients had pain syndrome as a result of acute injury of spinal column and
extremities; 1 patient had pseudo-organic pain syndrome in his legs.
Functional, biochemical and psychological methods, such as ultrasonic
dopplergraphy (USDG), electroencephalography (EEG), examination of energy
exchange of brain with the help of permanent potential level registration method
(LPP), variability of heart rate (VHR), method of multivariate (verbally-color) pain
evaluation, were applied along with clinical examination before and after the first
DENS session as well as after the treatment course. A number of biochemical
characteristics were determined: total antioxidant status (TAS) as an index of
multileveled system of antioxidant body protection as well as lipid peroxidation
(LPO); hormones that are in charge of stress-reaction; biochemical and hormonal
markers of carbohydrate, protein, lipid and mineral exchange; hormones of thyroid
gland.
Dynamic electroneurostimulation was carried out with the help of
“DiaDENS-T” apparatus in comfortable mode at frequency 77 Hz at the segmental
zones of spinal column, at the zones of local soreness, at the acupuncture points on
extremities in accordance with topography of affected segments of spinal column
as well as at the acupuncture points of combined effect.
All the treated patients showed positive dynamics: patients felt better, slept
better, their work capacity increased, their psycho emotional state became stabilize,
significantly decreased or totally disappeared pain syndrome (except for 1 patient
with psycho-organic syndrome). Well-defined effect could be seen after the first
session already, however, it was not stable. Significant reduction of pain syndrome
and in majority of cases its steady elimination was reached by 5 th-7th session.
Besides the pain syndrome the other clinical symptomatology regressed by 10 th12th session. Regress of the pain syndrome and the rest of the neurological
symptomatology of patients from the control group (group of patients with
vertebrogenous pain syndromes that got drug treatment, exercise therapy, physical
therapy, massage without DENS application) became apparent in significantly
longer time periods (after 5-6 weeks) and result of the treatment was not steady.
Blood flow research of the major extra cranial and peripheral arteries of the
lower extremities (according to the ultrasonic diagnostics data) showed positive
dynamics for almost all the patients in the process of DENS course treatment.
Tendency towards normalization of the cerebral and peripheral blood flow
developed starting from the first treatment session. Significant improvement of the
extra cranial cerebral blood flow could be seen already by the middle of the
treatment course. Electrostimulation application at the points of cervical-collar
zone helped to eliminate excess toner reactions in the area of vertebral artery and
internal carotid artery, helped to increase the speed of the blood flow in the
vascular channels of the brain and thus prevent development of functional
disorders of cerebral hemodynamics.
Electrostimulation at the acupuncture points of the lumbosacral region of the
spinal column was accompanied by improvement of the lower extremities’
hemodynamic characteristics, including patients with initial signs of occlusion
whose velocity characteristics for the majority of the studied arteries came near the
norm as a result of the treatment; that indicated improvement of arterial
permeability.
Thus, clinical effectiveness of dynamic electroneurostimulation was
accompanied by restoration of adequate responses of cerebral and peripheral
hemodynamics which was confirmed with ultrasonic diagnostics data.
Resulting from the spectral analyses VSR data was an evidence of a difficult
way to affect an adaptation. After the first procedure of electrostimulation a
defined increase in sympathetic activation could be seen; that was expressed in
increase of Bayevski’s index of tension (Picture 1) and mode amplitude.
Noticed in the process of treatment amplification of spectrum capacity of
slow waves was an evidence of over-segmental structures activation, including
nonspecific tube systems, diencephalic region, hypophysial-hypothalamic and
cortical level of blood flow regulation; it also showed reconstruction of adaptive
regulation mechanisms [1]. This tendency increased by the middle of the course;
decrease in the sympathetic activity and index of tension reduction was noticed
only after 7th-8th procedure (Picture 1).
It needs to be noticed that patients who initially had an increased arterial
blood pressure showed similar dynamics of ABP – at first there was a small
increase of pressure, after the 6th-8th procedure a tendency towards normalization
and gradual decrease of pressure was noticed which reached a point at 10-12 units
in comparison with initial data after the treatment course.
Picture 1. Index of tension dynamics in variability of heart rate research at
the time of DENS application.
190
170
150
130
110
90
70
50
Background
1 session Middle of
the course
Course
Energy exchange of the brain research with the help of permanent potential
level method (PPL) showed that DENS procedures were accompanied by defined
increase of energy exchange of the brain, which was well-marked the most in
frontocentral areas of dominant hemisphere; that caused an increase of
interhemispheric skewness. Gradual normalization of interhemispheric skewness
indexes and return of average energy exchange indexes to an age-specific norm
was noticed after the 6th-8th procedure. At the same time PPL in frontocentral areas
was slightly higher than initial one which was an evidence of
an activating
influence on the cortex from the direction of brainstem structures of diencephalic
level [13].
Signs of functional activation of the brain were discovered on an
electroencephalogram (EEG). Decrease of an alpha rhythm power, reduction of
zonal differences and increase of coherence level in cortical rhythm areas (alpha
and beta) were noticed after the first procedure; that is illustrated on the picture 2.
After the DENS course restoration of an alpha rhythm power and normalization of
interhemispheric skewness indexes were to be observed, however, coherence
indexes between the different areas of the brain in cortical rhythm areas remained
increased, which was an evidence of higher level of functional activity of the brain
in comparison with the background (Picture 2).
background
after the first procedure
after the DENS course
Picture 2. Distribution of spectral alpha rhythm power at the time of DENS.
According to the biochemical research data, all patients had initially lowered
total antioxidant status level (TAS), dynamics of which could be found on the
picture 3, as well as increased activity of lipid peroxidation (LPO). As is well
known, pain syndrome is accompanied by LPO activation, and stronger LPO is,
lower an antioxidant defense level would be. It is well known that oxidativeantioxidant balance maintenance (OAB) is the most important mechanism of living
systems homeostasis. Toxic effect of molecular oxygen of an atmosphere on
macromolecular and supramolecular structures of living organism determines the
necessity of constant OAB maintenance. As a result an activation of LPO
membranes and, accordingly, activation of free radical oxidation (FRO) takes
place. They are the cause of pathogenesis of numerous diseases of human being
such as cardiovascular, oncological diseases, inflammatory, infectious, dystrophic,
traumatic, radiation injuries and all the illnesses that are accompanied with pain
syndrome [2,4,5,15].
Picture 3. Dynamics of total antioxidant status (TAS) at the time of DENS
application.
1,4
1,3
1,2
1,1
1
0,9
0,8
0,7
0,6
0,5
norm
Background
1 session
course
Positive clinical DENS effect was accompanied by decrease of LPO activity
and increase of TAS level which was an evidence of antioxidant defense level rise
(Picture 3). These findings allow to assume that DENS is a method of antioxidant
defense increase which could play a certain part in the prophylaxis of oncological
diseases, cardiovascular pathology, inflammatory, infectious and degenerativedystrophic damages. However, this DENS effect takes place only at the positive
adaptation level. If patient is in chronic stress (in case of adaptation reserves
exhaustion), antioxidant defense does not increase; this fact could be observed in
the case with 2 patients who initially had lowered adaptation level.
In the presence of DENS therapy the majority of the patients (70%) showed
decrease of the level of such stress-realizing hormones as adrenocorticotropic
hormone (ACTH) and cortisol which is an evidence of defined impact of this
method on antistress and antinociceptive organism systems of patients. Only 30%
of patients who were in a state of enduring chronic stress, according to clinical
research data, showed an increase of ACTH indexes on the session of DENS
therapy; this fact could be considered as a development of stressful stimulative
analgesia.
The dynamics of somatotropic hormone (STH) also was monitored for the
studied patients in the process of DENS. Initially level of STH was significantly
decreased (background on the Picture 4.) for the majority of patients (70%) who
were at the stress and anxiety stage, according to the clinical research data. This
fact by implication was an evidence of immunity reduction for this category of
patients (taking into account impact and role of STH in the general state of
immune system). Initially lowered STH blood level of these patients increased due
to the course treatment. It reached the lower limit of physiological norm (course –
Picture 4) which by implication could be considered as an increase of immune
status of those patients. Stressful analgesia could be mentioned in this connection
as well.
Picture 4. STH dynamics in the DENS process.
norm
6
5
4
3
2
1
0
Background
1 session
course
Level of STH of 2 patients, who were in an enduring chronic stress, was
within the limits of reference zone and then decreased in a process of DENS; by
the end of the course it was lower then the norm which, on the one hand, could be
evaluated as a demonstration of antistress and analgesic action of DENS, on the
other hand, it could be considered an effort of AO-defense mechanisms, exhaustion
of AO-reserves that characterize an exhaustion stage of adaptive reserves.
A defined DENS effect on the carbohydrate exchange state that was
evaluated according to insulin, C-peptide and blood glucose level modification
dynamics was determined.
Due to the DENS effect the majority of patients showed a certain reduction
of insulin in the blood within the physiological norm. That was a strong stimulus
for the secretion of new amount of insulin and allowed to speak about
autoregulation of insulin secretion [4]. After the DENS course patients with
initially normal indexes of insulin level showed its restoration almost to the
reference level; 2 patients with the small insulin level reduction up to the lower
limit of the norm even showed its gradual increase in comparison with the
reference level. Similar dynamics was determined regarding C-peptide and blood
glucose reduction which is an indirect sign of the brain energy exchange level
increase.
On the basis of carbohydrate exchange dynamics data it is possible to
assume that DENS assists a carbohydrate exchange autoregulation which could be
an indication for this method to be used for the prophylaxis and treatment of
pancreatic diabetes.
There was determined a correlation of the positive clinical dynamics in the
presence of hormonal status of the thyroid gland normalization which was reduced
for the majority of patients before the treatment (Picture 5). These results are an
evidence of defined thyrotropic action of dynamic electroneurostimulation and a
possibility of application of this method for the hypothyroidism prophylaxis and
treatment.
Picture 5. Dynamics of peripheral convertation index of thyroid gland
hormones in DENS process.
norm
8
7
6
5
4
3
2
1
0
Background
1 session
сourse
Thus, data received is an evidence of great opportunities of dynamic
electroneurostimulation not only in the struggle against pain syndrome. DENS is
aimed at the regulatory and protective organism subsystems activity increase, at
the body resistance increase and homeostasis normalization. Engaging of the
antioxidant defense mechanisms in case of DENS application was revealed. The
correlation between the reduction of the pain syndrome and increase of the total
antioxidant status level due to the effect of dynamic electroneurostimulation
therapy was displayed at the first time.
Level reduction of such stress-realizing hormones as ACTH and cortisol for
the majority of the patients shows the pronounced effect on antistress and
antinociceptive organism systems of patients.
The dynamics of insulin, C-peptide and glucose level taking into account
insulin secretion autoregulation allows to make an assumption about the engaging
of anabolic reactions of the body and further energy potential strengthening. That
was confirmed with the physiological research data (VSR, PPL, EEG) where clear
signs of oversegmental structures activation were determined.
Taking into consideration all the above, it could be concluded that
sanogenetic action of dynamic electroneurostimulation therapy in treatment of pain
syndromes occurs at first because of the activation and stress mobilization of
energy recourses of the brain. At the same time centralization intensifies, the role
of cortical structures of the brain in homeostasis regulation increases as due to the
activation of dominant hemisphere of the cerebral cortex, as well as due to the
activation of stem structures of diencephalic level where the major control centers
of the hormonal exchange and maintenance of the main homeostatic constants
exist. Later on (after the DENS course is over) the decentralization of the process
and gradual normalization of electrophysiological and biochemical indexes takes
place.
All that allows to consider DENS a version of activation therapy according
to Garkavi L.H., Kvakina E.B., meaning the therapy that is used by calling and
maintaining antistress reactions of the body which result in increase of activity of
regulatory and defense body subsystems as well as in resistance increase and
homeostasis normalization [3]. This is the method of nonspecific pathogenetic
therapy. The goal of this therapy is to take the body out of the stress condition for
the stress is the cause of many pathological processes including pain syndromes.
At the same time, necessary functional state forms at which body is able to fight
the existing disorders by itself, that is an impact on the pathologic process is
mediate. With all that systematic repetition of the actions according to the special
algorithm is necessary for the maximum therapeutic effect to be reached (since the
effect of one-time or facultatively repetitive actions is quite brief); careful selection
of the action dose is essential, especially for the patients who suffer from severe
chronic illnesses for a long time and have initially low adaptation level, for whom
it is necessary to reduce the load not to ruin the adaptation and worsen there
general state.
In this connection, in order to prevent the action overdose the special mode
was developed. It is called the mode of “minimal effective dose” and is realized in
the “DENAS” and “DiaDENS-T” apparatuses. On the basis of automatic analyses
of impedance dynamics in the subelectronic zone this mode allows to select for
each patient an individual safe action dose which causes steady therapeutic effect
[12].
All the received information allows to broaden the sphere of application of
dynamic electroneurostimulation method and to recommend it as a method of
physio- and reflex therapy both in treatment of pain syndromes and in complex
treatment of wide variety of illnesses concerned with reduction of body resistance
and different ways of homeostasis disturbance.
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