Effectiveness of Transcutaneous Electrical Nerve Stimulation by experimently inducing pain

Project Title

Effectiveness of Transcutaneous Electrical Nerve Stimulation by experimently inducing pain

Project Area of Specialization NeuroTechProject Summary

Pain is a signal that occurs due to a result of nerve stimulation and is sensed by our nervous system. It may occur due to tissue damage that is referred as nociceptive pain or it may occur due to nerve damage which is referred as neuropathic pain. Our main focus is nociceptive pain.We will be experimentally inducing pain into the subject’s body,  experimentally inducing pain techniques includes: mechanical stimulation, thermal stimulation, electrical stimulation and chemical stimulation. We will apply thermal stimulation technique using cold pressor test in which pain of specific intensity level ,that a person could tolerate, is provided through iced water. Pain intensity may be measured from pain scales or as well as through Electroencephalogram (EEG). Pain scales include: Numerical Rating Scale (NRS), Visual Analog Scale (VAS), Faces Rating Scale (FRS), Verbal Pain Intensity Scale, MC Gill Pain Questionnaire (MPQ), Brief Pain Inventory (BPI) and Initial Pain Assessment Tool but we will measure pain intensity through EEG.

After experimentally inducing pain, neuromodulation technique is applied to reduce pain intensity. Neuromodulation is a treatment or therapy that undergoes stimulation of nervous system through different techniques. There are two types of neuromodulation techniques: invasive neuromodulation and non-invasive neuromodulation. Invasive neuromodulation techniques include: Sacral Neuromodulation (SNM), Functional Electrical Stimulation (FES), Vagus Nerve Stimulation (VNS), Percutaneous Tibial Nerve Stimulation (PTNS), Occipital Nerve Stimulation (ONS) and Intrathecal Drug Delivery Systems (ITDS) whereas non-invasive neuromodulation techniques include: Transcranial Pulsed Electromagnetic Fields (tPEMF), Repetitive Transcranial Magnetic Stimulation (rTMS), Electroconvulsive Therapy (ECT), Transcranial Direct Current Stimulation (tDCS) and Transcutaneous Electrical Nerve Stimulation (TENS). The neuromodulation technique that we will apply is Transcutaneous Electrical Nerve Stimulation (TENS) which is a non-invasive battery operated therapeutic device that uses electrical stimulation for pain relief. The effectiveness of TENS we will analyzed  through EEG at different time intervals.

Project Objectives

The objective of our project is to see how much effective is Transcutaneous Electrical Nerve Stimulation (TENS) in pain relief ,decreasing pain intensity and increasing pain tolerance, by experimentally inducing pain using cold pressor test. We also observe effects in different parts of the brain at different intervals using Electroencephalography(EEG).

Project Implementation Method

This experiment comprises of 5 healthy subjects of ages between 18 to 40 years. They are divided into 3 groups: sham group, high intensity group and low intensity group. EEG is recored using 14 channel Emotiv Epoc + device. For cold pressor test, the water is chilled in cooler compressor Dometic CoolFun CK 40D Hybrid at temperature ranging between 1°C and -3°C. TENS is provided using inTENSity Select Combo II device.

Pre treatment involves first EEG  recording for 5 minutes in the relaxed state with the eyes closed then cold pressor test is performed. The subject is told to place his hand in warm water, set at a temperature of about 35 to 37°C , to maintain the temperature of hand at room temperature then place hand in iced water for 5 minutes for experimentally inducing pain. During cold pressor test the EEG is simultaneously recorded for analysing pain intensity and pain tolerance. After cold pressor test, treatment is done using TENS which is provided at specific intensities for 5 minutes to analyse its effects on pain intensity and pain tolerance. Also EEG recording is done during the application of TENS. In post treatment, EEG is recorded after 15 minutes when the TENS was switched off and then again after 30 minutes .

Benefits of the Project

It is a drug free, non invasive solution to instant pain relief with no side effects. Moreover, TENS releases our body's natural painkiller, endorphins as well as blocks the pain pathway, preventing the pain signal to reach the brain. Also it is portable equipment and can be easily used at home after help and understanding from a physician.

Technical Details of Final Deliverable

Hardware Components

The components that we are using in our project are as follows:

• Compressor cooler
• TENS unit
• EEG Emotiv Epoc+ device

1. Cooler compressor: It is use for cooling purposes for cold pressor test. it works similar to compressor in refrigerator.
2. TENS unit: TENS unit comprises of skin electrode, wires and TENS device. TENS device is a non-invasive battery operated therapeutic device that uses electrical stimulation for pain relief.
3. Emotiv Epoc+ : 

It is a 14-channel EEG device, consisting of saline based electrodes with 2 reference electrodes,and has wireless connection feature through doungle. It is rechargable and lasts upto 12 hours. Its sampling frequency is 128Hz/sec. These 14 channels read signals from 14 different areas of brain through electrodes. It is flexible and fast setup device. The signal recorded in the form of brainwaves are transformed and processed to digital form and the results are transmitted wirelessly to the receivers of the USB. The 14 channels of the EEG device are as follows:

CHANNEL	NAME	CHANNEL NUMBER
AF3	Anteriofrontal	Channel 3
F7	Frontal	Channel 4
F3	Frontal	Channel 5
FC5	Frontal cortex	Channel 6
T7	Temporal	Channel 7
P7	Parietal	Channel 8
O1	Occipital	Channel 9
O2	Occipital	Channel 10
P8	Parietal	Channel 11
T8	Temporal	Channel 12
FC6	Frontal cortex	Channel 13
F4	Frontal	Channel 14
F8	Frontal	Channel 15
AF4	Anteriofrontal	Channel 16

Position of electrodes on head are as follows:

Software Component

We have use TestBench software. The software collects the data from Emotiv device obtained via usb and displays results in realtime after analyzing, recording and then displays time dependent results. The software is also compatible with different versions of Windows making it user friendly.

CHANNEL

AF3

F7

F3

FC5

T7

P7

O1

O2

P8

T8

FC6

F4

F8

AF4

Final Deliverable of the Project HW/SW integrated systemType of Industry Medical Technologies NeuroTechSustainable Development Goals Good Health and Well-Being for PeopleRequired Resources

Elapsed time in (days or weeks or month or quarter) since start of the project	Milestone	Deliverable
Month 1	Literature review on pain	Learnt effectiveness of project
Month 2	Literature review on neuromodulation	Learnt effectiveness of project
Month 3	Literature review on TENS	Learnt effectiveness of project
Month 4	Literature review About thermal Sensation	Learnt effectiveness of project
Month 5	Understanding the EEG device and EEG recording	Learnt handling of EEG device
Month 6	Practicing EEG Data recording	Training on EEG Device
Month 7	Hands on practice of TENS device	Familiarization with TENS device
Month 8	Data Collection of 5 Subjects	Analysis of Subject