Front Matter

Chapter 7 Rehabilitation Physical Modalities 151

Finally, NMES has shown benefit for specific
patient types, some of which may translate well
to the canine patient. Elnaggar found improved
shoulder function and bone mineralization
when NMES was combined with weight‐bear­
ing exercises in children with obstetric brachial
plexus injury (Elnaggar, 2016). NMES can also
help maintain residual limb muscle strength
following amputation while patients await
arrival of their prostheses (Talbot et al., 2017).
Pan and colleagues showed that NMES improves
the muscle dysfunction resulting from chronic
intermittent hypoxia in rats (Pan et  al., 2016),
potentially indicating a treatment for weakness
in dogs with laryngeal paralysis. Finally, multi­
ple studies have demonstrated the potential for
muscular strength gains in patients following
spinal cord injury (Bickel et al., 2015; Gorgey
et al., 2016), resulting in improved functional
mobility (Beaumont et al., 2014).

Transcutaneous electrical nerve
stimulation (TENS)

The form of ES most often used for pain relief
is TENS. Conventional TENS is used to stimu­
late sensory nerves rather than motor nerves
(Figure  7.13). This is believed to reduce pain
perception through several possible mechanisms
including the gate theory of pain inhibition
(Melzack & Wall, 1965), activation of endoge­
nous opioids, and/or suppression of spinal

substance P and pro‐inflammatory cytokines

(Chen et al., 2015). This enables patients who

were limited by pain to participate more fully

in their rehabilitation program. TENS may also

benefit patients who are unable to tolerate pain

medications.

Evidence supporting the use of TENS

Therapeutic effects on pain

TENS has been used for pain relief for decades,

and recent research has provided additional evi­

dence to support its use. There are now studies

that promote TENS in addressing orthopedic

pain (Valenza et al., 2016; Son et al., 2017), nerve

pain (Upton et al., 2017), acute pain (Johnson

et al., 2015), chronic pain (Gozani, 2016), myo­

fascial pain (Azatcam et al., 2017), postoperative

pain (Chughtai et al., 2016), complex regional

pain syndrome (Bilgili et al., 2016), and pain

associated with cancer (Loh & Gulati, 2015).

Several studies have found that TENS can

decrease the need for pain medications (Pivec

et al., 2015; Gozani, 2016; Jauregui et al., 2016).

TENS can also be effective in the management

of pain associated with neurological diagnoses.

In a review by Sawant and colleagues, evidence

was found that TENS provides benefits toward

management of central pain in patients with

multiple sclerosis (Sawant et al., 2015) and the

neuropathic pain frequently experienced follow­

ing spinal cord injury (Özkul et al., 2015).

Figure 7.13 Example of a transcutaneous electrical nerve stimulation (TENS) unit.