經皮神經電刺激在針刺肌電圖檢查時之止痛效果

The Hypoalgesic Effect of TENS during Needle EMG Study

蘇王麟(Wang-Lin Su) ； 林璇怡(Hsuan-Yi Lin) ； 胡國琦(Gwo-Chi Hu)

《台灣復健醫學雜誌》 34卷4期 (2006/12) Pp. 235-240

https://doi.org/10.6315/2006.34(4)05

摘要

針刺肌電圖檢查在復健醫學上是一項重要的評估工具，但其造成的疼痛常使受測者，甚至施測者產生困擾，有時令檢查難以順利進行。在過去，針對如何減輕針刺肌電圖檢查造成的疼痛的處理有一些研究，但提出的方法都有其顯而易見的缺點。經皮神經電刺激(TENS)是一個被廣為接受及使用的止痛方法，其在針刺肌電圖檢查時是否有減痛效果，則尚未看到有研究報告被提出。本研究的目的是希望透過雙盲，隨意，安慰－控制(placebo-control)的方法來評估TENS在針肌電圖檢查時是否能有意義地減輕疼痛。
本研究使用正常電量100Hz TENS 為實驗組（共31人），微小電量2HzTENS為對照組（共28人），在病人被針刺檢查上肢的對側上下肢合谷，曲池，太衝，陽陵泉4個穴位通電。採用100毫米視覺類比量表(VAS)來量化評估患者的疼痛程度。結果顯示在性別、年齡、電學診斷不正常的比率、檢查左右手的比率、檢查前VAS 分數方面，兩組在統計上並無明顯差異（P值各為0.3831、0.1404、0.6931、0.5188、0.0629）。而兩組在檢查前後疼痛程度的變化，實驗組顯示可以有意義地被降低（Ｐ值為0.0003）。TENS是復健醫學常用的減痛工具，簡單，容易操作，不花費太多時間。比起過去被報導過的方法顯然更有優勢，值得大家嘗試使用。

關鍵字

肌電圖 ； 經皮神經電刺激 ； 針灸穴位 ； 疼痛控制

並列摘要

Needle electromyography (EMG) is an important diagnostic and prognostic tool in physical medicine. However, some patients are unable to tolerate the pain associated with the procedure. While there has been research in methods aimed at reducing the pain from needle EMG, all have obvious disadvantages.TENS is a widely accepted tool for producing analgesia, but it has not been studied as an analgesic adjunct to needle EMG. We designed a double-blind, randomized, placebo-controlled study to investigate the effectiveness of TENS on alleviating the pain during a needle EMG study.
Fifty-nine subjects undergoing needle EMG study in an upper extremity were randomly assigned into the experimental group (31 patients) and the placebo group (28 patients). For the experimental group, TENS was applied at a pulse rate of 100Hz and a pulse width of 200 μs during the whole course of EMG study. The placebo group was treated similarly except for a pulse rate of 2Hz, essentially a sham TENS procedure. TENS electrodes were placed over acupuncture points He Gu (LI4), Gu Chi (LI-11),Tai Chong (LIV3), and Yang Ling Quan (GB34) on the limb contralateral to the one undergoing EMG study. The subjects were asked to quantify the pain they experienced during EMG study by using a 100 mm visual analog scale (VAS). The experimental group experienced significantly less pain during needleEMG study than the control group (7.35±32.37 vs. 41.36±35.45, p=0.0003). TENS appears to be a useful tool in providing anesthesia during needle EMG study. It is a commonly available modality that is easy to operate without requiring too much time.

並列關鍵字

electromyography ； transcutaneous electrical nerve stimulation ； acupuncture point ； pain control