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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.

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 5th-7th session. Besides the pain syndrome the other clinical symptomatology regressed by 10th-12th 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.

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 oxidative-antioxidant 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.

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 degenerative-dystrophic 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.

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.

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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