title: Effectiveness of High-Frequency Electrical Stimulation Following Sensitization With Capsaicin.
abstract: Although nonnoxious, high-frequency electrical stimulation applied segmentally (ie, conventional transcutaneous electrical nerve stimulation [TENS]) has been proposed to modulate pain, the mechanisms underlying analgesia remain poorly understood. To further elucidate how TENS modulates pain, we examined evoked responses to noxious thermal stimuli after the induction of sensitization using capsaicin in healthy volunteers. We hypothesized that sensitization caused by capsaicin application would unmask TENS analgesia, which could not be detected in the absence of sensitization. Forty-nine healthy subjects took part in a series of experiments. The experiments comprised the application of topical capsaicin (.075%) on the left hand in the C6 dermatome, varying the location of TENS (segmental, left C6 dermatome, vs extrasegmental, right shoulder), and assessing rating of perception (numeric rating scale: 0-10) and evoked potentials to noxious contact heat stimuli. The extrasegmental site was included as a control condition because previous studies indicate no analgesic effect to remote conventional TENS. Conventional TENS had no significant effect on rating or sensory evoked potentials in subjects untreated with capsaicin. However, segmental TENS applied in conjunction with capsaicin significantly reduced sensation to noxious thermal stimuli following a 60-minute period of sensitization.
  
  
  CONCLUSIONS
  The study indicates that sensitization with capsaicin unmasks the analgesic effect of conventional TENS on perception of noxious contact heat stimuli. Our findings indicate that TENS may be interacting segmentally to modulate distinct aspects of sensitization, which in turn results in analgesia to thermal stimulation.
authors: Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland. Electronic address: cjutzeler@paralab.balgrist.ch.
authors: Catherine R
authors: CR
authors: Jutzeler
authors: Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
authors: Armin
authors: A
authors: Curt
authors: Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland; School of Kinesiology, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
authors: John L K
authors: JL
authors: Kramer
mesh_terms: D000328:Adult; D055592:Biophysical Phenomena; D002211:Capsaicin / Q000494:pharmacology*; D004558:Electric Stimulation / Q000009:adverse effects; D005073:Evoked Potentials, Somatosensory / Q000187:drug effects / Q000502:physiology; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D017288:Pain Threshold / Q000187:drug effects* / Q000502:physiology*; D011930:Reaction Time / Q000187:drug effects / Q000502:physiology; D018689:Sensory System Agents / Q000494:pharmacology*; D013997:Time Factors; D004561:Transcutaneous Electric Nerve Stimulation; D055815:Young Adult
chemical_list: D018689:Sensory System Agents; D002211:Capsaicin
keywords: Transcutaneous electrical nerve stimulation; capsaicin; contact heat evoked potentials; experimental pain modulation