颈椎疼痛经皮电刺激治疗(TENS for Cervical Spine Pain)

  Transcutaneous Electrical Stimulation (TENS) for Cervical Spine Pain

  颈椎疼痛的经皮电刺激治疗

  A Patient’s Guide to Transcutaneous Electrical Stimulation (TENS) for Cervical Spine Pain

  颈椎疼痛经皮电刺激治疗的患者指南

Introduction

引言

 
  Neck (cervical spine) pain due to musculoskeletal disorders, is the second largest cause of time off work –low back pain being first. It is generally worse in the morning and evening. The most commonly prescribed intervention is rest and analgesics, and often a referral to physical therapy. Among the rehabilitation intervention treatments for neck pain is thetranscutaneous electrical nerve timulation (TENS) unit.
  
  因肌肉骨骼疾患所致的颈部(颈椎)疼痛,是造成误工的第二大原因——腰痛排名第一。疼痛通常在早晨和夜间加重。最常用的干预措施是休息和镇痛药物,物理治疗也常常被建议采用。经皮神经电刺激(TENS)仪就是康复理疗的一种。

  Electrical nerve stimulation is a treatment for pain that is usedprimarily for chronic pain. The electrical stimulation is delivered through electrodes or patches placed on the skin. The technique and the device used is called transcutaneous electrical stimulation or TENS for short.
  
  神经电刺激用于疼痛治疗,主要用于慢性疼痛。电刺激通过附着于皮肤的电极或者贴片来传递。这种技术和所使用的设备就叫做经皮电刺激(transcutaneous electrical stimulation,简称TENS)。

  TENS is a non-invasive way to override or block signals from the nerves to the spinal cord and brain. Pain messages may be altered enough to provide temporary or even long-lasting pain relief. Besides controlling pain, this type of electrical stimulation can also improve local circulation and reduce or eliminate muscle spasm.
  
  TENS是一种非侵入性的方法,用来覆盖或者阻碍信号从神经传到脊髓和大脑。疼痛信息可能被改变,从而足以提供临时的甚至长期持续的疼痛缓解。除了控制疼痛,这种电刺激还可以改善局部循环,降低或者消除肌肉痉挛。

This guide will help you understand

这个指南将帮助你了解

  who may benefit from a TENS unit

  how a TENS unit works

  what to expect with a TENS unit

  TENS可以帮助哪些人

  TENS如何工作

  TENS可以获得什么效果

Who may benefit from a TENS unit

谁可以从TENS治疗中获益


  TENS can be used for relief of pain associated with a wide variety of painful conditions. This may include back pain caused by spine degeneration, disc problems, or failed back surgery. Nerve pain from conditions such as chronic regional pain syndrome (CRPS) and neuropathies caused by diabetes or as a side effect of cancer treatment may also be managed with TENS.

  TENS可以用于缓解多种多样的疼痛病症。这些病症包括了脊柱退行性变、椎间盘问题或者失败的脊柱手术等导致的背痛。诸如慢性区域性疼痛综合征(chronic regional pain syndrome,简称CRPS)、糖尿病引起的神经病变以及恶性肿瘤治疗引起的副作用等神经性痛也可用TENS治疗。

  TENS has been used for people suffering from cancer-related pain, phantom-limb pain (a chronic pain syndrome following limb amputation), and migraine or chronic tension-type headaches.

  TENS已经被应用于癌痛患者、幻肢痛(截肢后的慢性疼痛综合征)患者、偏头痛及慢性紧张性头痛患者。

  TENS can also be used for muscle soreness from overuse, inflammatory conditions, and both rheumatoid and osteoarthritis. Athletes with painful acute soft tissue injuries (e.g., sprains and strains) may benefit from TENS treatment.

  TENS也可以用于过度使用产生的肌肉酸痛、炎性病症,类风湿性关节炎及骨性关节炎。运动员因急性软组织损伤(比如扭伤和拉伤)引起的疼痛也可能从TENS中获益。

  Sometimes it is used after surgery for incisional or post-operative pain from any type of surgery(e.g., joint replacement, cardiac procedures, various abdominal surgeries, cesaerean section for the delivery of a baby). Studies show that TENS can significantly reduce the use of analgesics (pain relievers, including narcotic drugs) after surgery.

  有时候TENS用于任何类型手术(例如关节置换、心脏手术、各种腹部手术、剖宫产手术等)后的切口疼痛。研究显示,TENS可以显著地降低镇痛剂(止痛药,包括麻醉药品)的使用。

  TENS is usually used along with other forms of treatment and pain control such as analgesics, relaxation therapy, biofeedback, visualization or guided imagery, physical therapy and exercise, massage therapy, nerve block injections, and/or spinal manipulation.

  TENS常常与其他的治疗形式和疼痛控制方式一起使用,例如镇痛剂、放松疗法、生物反馈疗法、视觉想象或者引导意象疗法、物理治疗和训练、按摩治疗、神经阻滞注射,和/或整脊疗法。

  The effectiveness of TENS remains controversial. The American Academy of Neurology (AAN) findings published in Dec. 30, 2009 issue of Neurology claims it is not effective and cannot be recommended. But, many patients find TENS effective for pain relief, easy to use, and with very low side effects. It may be worth a try for those who suffer from chronic low back pain. It can be discontinued easily if it doesn’t work. TENS cannot correct an underlying problem; it is only used for temporary relief of symptoms.

  TENS的效果还是有争议的。美国神经病学学会(AAN)在2009年12月30日发表的研究结果宣称这是无效的,不作推荐。但是,很多患者发现TENS可以有效缓解疼痛,使用方便,并且副作用很小。对于那些受慢性腰痛困扰的人,这值得尝试。如果没有产生效果,中止治疗也很容易。TENS只是用于暂时缓解症状,不能治疗基础疾病。

  TENS is a non-invasive way to override or block signals from the nerves to the spinal cord and brain. Pain messages may be altered enough to provide temporary pain relief. Besides controlling pain, this type of electrical stimulation can also improve local circulation and reduce or eliminate muscle spasm.

  TENS是一种非侵入性的方法,用来覆盖或者阻碍信号从神经传到脊髓和大脑。疼痛信息可能被改变,从而足以提供临时的甚至长期持续的疼痛缓解。除了控制疼痛,这种电刺激还可以改善局部循环,降低或者消除肌肉痉挛。

  To summarize, the benefits from TENS treatment can include:

  总结来说,TENS治疗的益处包括:

  pain relief

  increased circulation and healing

  decreased use of pain relievers or other analgesic drugs

  increased motion and function

  缓解疼痛

  改善循环,加速愈合

  减少镇痛药物的使用

  改善活动和功能

How does TENS work?

TENS的工作原理


  TENS produces an electrical impulse that can be adjusted for pulse, frequency, and intensity. The exact mechanism by which it works toreduce or even eliminate pain is still unknown. It is possible there are several different ways TENS works. For example, TENS may inhibit (block) pain pathways or increase of the secretion of the pain reducing substances (e.g., endorphins, serotonin) in the CNS.

  TENS产生一种可以调节波形、频率和强度的电脉冲,其降低甚至消除疼痛的确切机制还并不明确。TENS可能通过多种途径而起效。例如,TENS可能阻碍了疼痛通路,或者让中枢神经系统分泌更多的可以减轻疼痛的物质(例如,内啡肽、5-羟色胺)。

  Electrical nerve stimulation is a treatment for pain that is used primarily for chronic pain. The electrical stimulation is delivered through electrodes or patches placed on the skin. The technique and the device used is called transcutaneous electrical neurostimulation  or TENS for short.

  神经电刺激是一种疼痛治疗手段,主要用于慢性疼痛。电刺激通过放置在皮肤上的电极或者贴片来传递。这种技术和采用的装置叫做经皮神经电刺激(transcutaneous electrical stimulation,简称TENS)。

  TENS is a non-invasive way to override or block signals from the nerves to the spinal cord and brain. Pain messages may be altered enough to provide temporary or even long-lasting pain relief. Besides controlling pain, this type of electrical stimulation can also improve local circulation and reduce or eliminate muscle spasm.

  TENS是一种非侵入性的方法,用来覆盖或者阻碍信号从神经传到脊髓和大脑。疼痛信息可能被改变,从而足以提供临时的甚至长期持续的疼痛缓解。除了控制疼痛,这种电刺激还可以改善局部循环,降低或者消除肌肉痉挛。

  Recent research has also shown that autosuggestion or the placebo effect is a powerful way many people experience pain relief or improvement in symptoms. Simply by believing the treatment (any treatment, including TENS) will work has a beneficial effect on the nervous system. Many studies have shown that people get pain relief through the placebo effect alone.

  新近的研究也显示了,很多人发现自我暗示或者安慰剂效应也是很有效的方式,可以获得疼痛的缓解或者症状的改善。只需要通过相信这个治疗(任何治疗,包括TENS)有效,就会对神经系统产生有益的作用。很多研究显示了,仅仅通过安慰剂效应也能让人们获得疼痛的缓解。

How do I use my TENS unit?

TENS仪使用方法


  You will be shown how to use your TENS device by your healthcare provider trained in the set-up and use of this modality. Round or square rubber electrodes are applied to the skin over or around the painful area. Usually four electrodes (two pairs) are used to get maximum benefit from this treatment.

  受过训练的医疗工作者会给你演示如何调试和使用你的TENS设备。在疼痛区域上或其周围放置圆形或者方形的橡胶电极片。通常要用四个电极片(两对)来取得最大的治疗效果。

  The electrodes are self-adhesive with a protective layer of gel built in to prevent skin irritation or burning. The unit is battery-operated with controls you manipulate yourself to alter the strength of the electrical signal. The unit can be slipped into a pocket or clipped to your belt. You may use two or four electrodes.

  电极片是自粘式的,有一层凝胶的保护层来防止皮肤刺激或者灼伤。设备是使用电池供电的,附有控制器可以让你自己调节电信号的强度,而且可以放进口袋里或者挂在你的皮带上。你可以使用两个或者四个电极片。

  The electrodes will be placed on your body at positions selected by a physician or physical therapist. The electrode placement is determined based on the location of the involved nerves and/or the location of your pain.

  电极片将被放置到你身上,位置由医生或者物理治疗师来选定。决定在哪里放置电极片,要基于相关的神经和/或你疼痛的部位。

  The first place to try the electrodes is either directly over the painful area or on either side of the pain. You will slowly turn up the intensity of the unit until you feel a buzzing, tingling, or thumping sensation strong enough to override the pain signals.

  初次尝试贴电极片的位置可以直接在疼痛区域上面或者在其两侧。你要缓慢地调高设备的强度,直到你得到震动、刺痛或者重击的感觉可以掩盖疼痛信号为止。

  If that doesn’t work, you may get better results putting the electrodes over the area where the spinal nerve root exits the vertebra. Sometimes it takes a bit of trial and error to find the right settings and best electrode placement for you.

  如果那样没有效果,改变电极片的位置到脊神经穿出椎体的区域,可能会得到更好的结果。有时候这需要尝试几次,才能找到正确的设置和最佳的电极放置点。

  Be sure and let your healthcare provider know if you experience increased pain. Electrodes placed below the level of a peripheral nerve impairment might actually block the input from the TENS unit and cause increased pain. Or placement over an area of scar tissue from surgery can cause increased skin resistance and decreased transmission of the electrical impulses.

  如果你感觉到疼痛加重了,一定要让你的医生知道。把电极片放置在周围神经损害层面以下可能实际上阻碍了TENS的输入,并引起疼痛加重。或者放置在手术疤痕区域,会增加皮肤的抵抗性,并降低电脉冲的传输。

  Another way to use TENS is over spots in the muscles that trigger pain called trigger points (TrPs). Trigger points are areas of hyperirritability in the muscles that can cause chronic pain. The healthcare provider will identify any TrPs present during your exam. Usually TrPs are taken care of with a treatment designed to eliminate them. In some patients they are chronic and don’t go away or come back easily. In such cases, TENS may be helpful.

  使用TENS的另一种方法是放置在肌肉可以激发疼痛的点上,这种点叫做激痛点(TrPs)。激痛点是肌肉里应激性亢进的区域,可以引起慢性疼痛。医疗保健人员会在给你检查时识别TrPs的存在。通常对付TrPs要用可以消除它们的治疗手段。对于某些患者,它们是慢性的,并不会来去自由。
相关视频:

  骨科疾病早知道014:触痛点(Trigger Point)

  骨科手术早知道084:触发点注射(Trigger Point Injections)

  Your health care team will guide you through the trial-and-error process for finding the best electrode placement for you and make any changes needed in the program.

  你的医疗团队会指导你,通过试错过程找到最佳的电极片放置方式,并在疗程中做出所需要的改变。

When you should NOT use TENS

TENS使用的禁忌症

  If you have loss of skin sensation or even decreased sensation, you should not use TENS. With altered sensation, there is a risk of turning the unit up too high and causing injury or harm.

  如果你皮肤感觉丧失,或者感觉减弱,那么不能使用TENS。感觉异常的情况下,可能会把仪器开得过高,造成损害的风险。

  The use of TENS is not recommended for older adults with Alzheimer’s, dementia, or other cognitive problems.

  TENS不建议用于患有阿尔茨海默病、痴呆症或者其他认知障碍的老年人。

  If you have a cardiac pacemaker, you should not use TENS as the electrical signals could interfere with your pacemaker. Cardiac patients should not use TENS without their physician’s approval.

  如果你安装了心脏起搏器,你也不能使用TENS,因为电信号会干扰你的起搏器。心脏病患者不经医生同意也不能使用TENS。


Some guidelines when using 

TENS一些使用指南

  Before applying the electrodes, it is important toremove all lotions, oils, or other applications to the skin. You may want to shave hair from the local area where the electrode will be applied.

  贴电极片之前,记住要除去所有的润肤乳、油,或者其他涂在皮肤上的东西,这很重要。你可能要剃去电极片附着处局部的毛发。

  Daily use of TENS for several hours at a time is recommended. You should not wear the unit for long periods of time (e.g., 24 hours) or during extended  sleep time (napping is okay but TENS should not be used while sleeping at night or for more than a couple of hours).

  推荐每天连续使用TENS的时间在几小时以内。不能长时间佩戴装置(例如,24小时),或者在睡眠时间使用(打盹儿没关系,但是TENS不能在夜间入睡时使用,或者在睡觉时使用超过几个小时)。

  Never place an electrode over an open wound or area of skin irritation. Report any skin problems or burns immediately.

  禁止在开放创口或者皮肤刺激区域放置电极片。如果发生任何皮肤问题或者灼伤,应立即报告。

  Do not place electrodes near your eyes or over your throat.

  不要在眼睛附近放置电极,或者贴在咽喉部。

  Do not use TENS in the shower or bathtub.

  不要在浴室或者浴缸里使用TENS。

  Move the electrodes a bit each time you put them on to avoid skin irritation.

  每次使用时要略微移动一下电极片的位置,这样可以避免皮肤刺激。

  You should experience a comfortable tingling sensation that is comfortable enough to allow you to complete daily tasks and activities.

  你应该得到舒适的针刺感,这种舒适的程度可以容许你完成日常工作和活动。

  You may want to keep a daily journal of your pain levels, the settings you use, and a record of the medications you are taking for pain relief. By reviewing your notes, you may find the best combination of electrode placement and unit settings that gives you the most pain relief.

  你可以记录每日的疼痛级别、你的设置模式,并且记录你用于缓解疼痛的药物。回顾你的笔记,你可能会找到电极放置和设备设置的最佳组合,这个组合可以最大程度地缓解疼痛。

What you can expect with TENS

TENS的疗效

  You should feel a mild to moderately strong tingling or buzzing sensation. Some people experience a more unpleasant sensation described as burning or prickling. Depending on the intensity and duration of your pain, you may or may not get results right away.

  你可能会感觉到轻到中等强度的针刺或者震动的感觉。有些人会有比较不舒服的感觉,像灼伤或者针刺。根据疼痛的强度和持续时间不同,治疗的效果可能即刻获得,也可能不能马上见效。

  It can take several days to even several weeks to get the desired results. Differences in results may occur based on properties of skin resistance, type of pain, and individual differences in the mechanism of pain control. Be patient and persistent. Do not hesitate to contact your healthcare provider as often as it takes to get the desired results.

  获得期待的疗效可能需要数天甚至数周。疗效的不同可能基于皮肤阻抗的属性、疼痛类型和镇痛机制的个体差异。要有耐心,坚持下去。想要获得满意的疗效,不要犹豫经常联系您的医生。

  Many patients doreport good-to-excellent results, first with pain control, then pain relief, and finally reduction in the use of medications. Although it doesn’t happen for everyone, some chronic pain patients are “cured” permanently from their pain.

  很多患者确实获得了良好到优异的疗效,开始是疼痛控制,然后是疼痛缓解,最后减少药物使用。虽然不是每个人都有,但是一些慢性疼痛患者的疼痛确实被彻底“治愈”了。

  As each of these benefits from the TENS treatment occur, you may find yourself increasing your activity level – either with the same level of TENS usage or even with reduced frequency of use, intensity of signal, or duration (length of time the unit is turned on).

  伴随着TENS治疗的良好效果逐一实现,你可能会发现即便在同样的TENS治疗水平下,甚至降低了使用频率、信号强度或者使用时间(设备打开的时间长度),你的活动能力也在逐步地改善。

  If for any reason your pain starts to increase in frequency, duration, or intensity, don’t assume the treatment isn’t working for you. First, check the TENS unit for any malfunction, need torecharge, or replace the electrodes with new ones. If your unit is battery-operated, you may find it necessary to turn the intensity up to obtain the same sensation when the batteries are low. This should alert you to the need for battery replacement.

  如果因为任何原因,你疼痛的频度、持续时间或者强度开始加重,不要臆想这个治疗对你无效。先要检查TENS设备是否有故障,需要充电,或者替换新的电极。如果你的设备是电池供电的,你可能会发现如果电池电量弱的时候,有必要将强度调高才能获得同样的感觉。这也提醒了你需要更换电池了。

  Finally, be aware that some patients experience “breakthrough pain,” referring to a situation in which you get pain relief at first but then even with the TENS unit, you start to have pain once again. Turning the intensity up high enough to cause muscle contraction is an indication of breakthrough pain.
  
  最后,注意有些患者会体验“突破性的疼痛”。这是指一开始获得了疼痛缓解,但是后来虽然仍在使用TENS,却再次开始疼痛了。强度调高到产生肌肉收缩是突破性疼痛的一个标志。

  Sometimes a different setting for the stimulator may be needed when this happens. Most units have a setting that allows for random pulse frequency, duration, and amplitude. The use of this setting helps keep the nervous system from getting used to a specific amount of stimulation and ignoring it. This phenomenon is called habituation or adaptation.

  有时候发生这种情况了,可能需要采用另一种刺激模式。大多数设备可以随意设置波的频率、持续时间和振幅。这样的设置能帮助防止神经系统适应某一特定的刺激,继而对此失去反应。这种现象叫做习惯(habituation)或者适应(adaptation)。

Summary

小结

  TENS is an effective method of pain control for chronic pain when you want to maintain your normal routine of daily activities that would otherwise be hampered by too high of pain levels. TENS helps many people reduce and sometimes even eliminate the use of pain medications, thus avoiding side-effects of long-term drug use.

  如果你的慢性疼痛程度很严重,TENS是一种有效的疼痛控制手段,可以让你继续维持日常活动。TENS帮助很多人减少了镇痛药物的使用,有时候甚至可以完全不用,从而避免了长期用药的副作用。

  Even without complete pain relief, TENS makes it possible to stay active and participate in work, family, and even recreational activities. There are no significant adverse effects from the use of TENS. The ability of this treatment technique to moderate pain and reduce the use of pain medications is a real benefit — especially with the potential for serious or adverse effects from long-term use of pain relievers.

  即使不能完全缓解疼痛,TENS也可以使得保持活力,参与工作和家庭事务,甚至参加娱乐活动变成可能。使用TENS没有明显的不良反应。这种治疗技术可以控制疼痛和减少镇痛药物的使用,这是一种实实在在的好处,尤其是对于长期使用镇痛药物可能造成的严重不良反应。

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