Transcutaneous Electrical Nerve Stimulation Therapy Research Articles

Comparative Efficacy of Carbamazepine Therapy With and Without Transcutaneous Electrical Nerve Stimulation Therapy in Trigeminal Neuralgia Patients: A Randomised Controlled Trial Protocol

Introduction: Trigeminal Neuralgia (TN) is one of the most painful diseases. Typically, medication therapy starts at an initial titrated dose of 100 mg every other day of Carbamazepine (CBZ) 200-1200 mg/day. There is less evidence to support secondline treatments such as clonazepam, valproic acid, baclofen, gabapentin, lamotrigine, and baclofen. Transcutaneous Electrical Nerve Stimulation (TENS) is a widespread technique used for managing neuropathic pain. TENS therapy, which involves the transmission of an electric current across the intact skin surface to activate deeper nerves in an attempt to relieve pain, is a recent and promising alternative for the treatment of both acute and chronic pain. Need of the Study: Few research has been done on TENS therapy for pain management in TN. These studies have poor study designs, no control groups, and unclear information regarding the type of concurrent pharmacological therapy. TENS in combination with CBZ may reduce the dose of CBZ therapy, therefore, there is a need to conduct the study on “Comparative efficacy of CBZ therapy with and without TENS therapy for the management of TN”. Aim: To evaluate and compare the efficacy of CBZ therapy with and without TENS therapy for the management of TN. Materials and Methods: A Randomised Controlled Trial (RCT) will be conducted in the Outpatient Department (OPD) of Oral Medicine and Radiology at Sharad Pawar Dental College and Hospital, Wardha, Maharashatra, India between July 2024 and May 2026. Once diagnosed and enrolled, 38 individuals between the ages of 20 years and 80 years will receive a primary diagnosis of TN will be included and they will receive further treatment, based on International Headache Soceity (IHS) diagnostic criteria (IHS, 2018). Then these patients will randomly be allocated to one of the following groups, 19 subjects in each group, respectively: Group 1 (CBZ therapy): The baseline parameters of patients will be evaluated who will be treated with CBZ Initially at 100 mg TDS per day (300 mg), the patient will receive an additional titrated dose 100 mg of CBZ every 48 hours until they reach the maximum tolerated dose or total relief and Group 2 (CBZ with TENS therapy): CBZ initially, at 100 mg TDS per day (300 mg), the patient will receive an additional titrated dose 100 mg of CBZ every 48 hours until they reach the maximum tolerated dose or total relief. The pulse duration of TENS therapy will be 125 µS. The TENS will be applied during the first twenty minutes at a low frequency (2 to 10 Hz) and the last twenty minutes at a high frequency (50 to 100 Hz), with no break in between, for a total of 40 minutes per session. The outcome of Group 2 will be more efficacious in reduction of Visual Analogue Scale (VAS) score as compare to Group 1. The statistical analysis will be performed using Chi-square test at 5% level of significance (p<=0.05).

Comparative Evaluation of Salivary Flow Rate in Oral Submucous Fibrosis Patients before and after Transcutaneous Electric Nerve Stimulation: A Research Protocol

Introduction: A persistent, precancerous, and frequently debilitating condition-Oral Submucous Fibrosis (OSMF) is characterised by a slowly progressing fibrosis of the oropharynx and oral cavity. A reduction in salivary flow is one of the common symptoms experienced by sufferers. Using electric current to stimulate nerves, Transcutaneous Electric Nerve Stimulation (TENS) can be an effective method for improving salivation. TENS serves as a simple, affordable, and non invasive approach that can decrease the discomfort associated with long-lasting hyposalivation. Need of the Study: Although the effectiveness of TENS on salivary flow rate has been studied in various conditions, there is a lack of evidence or studies describing the effect of TENS on salivary flow rate in patients with OSMF. This has led to the intention of the present study. Aim: To evaluate and compare the salivary flow rate in OSMF patients before and after TENS. Materials and Methods: This prospective research investigation will be conducted in the Department of Radiology and Oral Medicine, Sharad Pawar Dental College and Hospital, Sawangi, wardha, Maharashtra, India, from February 2024 to January 2025. Patients aged between 18 and 45 years suffering from OSMF will be included in the study, evaluated based on the Inventory of Xerostomia (XI) questionnaire to confirm reduced salivation. Each patient will receive TENS treatment at 40 Hz for 15 minutes. The Modified Schirmer Test (MST) will be used to evaluate the salivary flow rate before and after TENS therapy. All findings will be recorded in a tabular format and subjected to appropriate statistical tests to evaluate the statistical significance regarding the improvement in salivary flow rate.

Transcutaneous electrical nerve stimulation for fibromyalgia-like syndrome in patients with Long-COVID: a pilot randomized clinical trial

This study investigated the effect of Transcutaneous Electrical Nerve Stimulation (TENS) for fibromyalgia-like symptoms including chronic widespread musculoskeletal pain, fatigue, and/or gait impairment in twenty-five individuals with long-COVID. Participants were randomized to a high dose (intervention group, IG) or low dose (placebo group, PG) TENS device. Both groups received daily 3–5 h of TENS therapy for 4-weeks. The Brief Pain Inventory assessed functional interference from pain (BPI-I), and pain severity (BPI-S). The global fatigue index (GFI) assessed functional interference from fatigue. Wearable technology measured gait parameters during three 30-feet consecutive walking tasks. At 4-weeks, the IG exhibited a greater decrease in BPI-I compared to the PG (mean difference = 2.61, p = 0.008), and improved in gait parameters including stride time (4-8%, test condition dependent), cadence (4-10%, depending on condition), and double-support phase (12% in dual-task) when compared to baseline. A sub-group meeting the 2010 American College of Rheumatology Fibromyalgia diagnostic criteria undergoing high-dose TENS showed GFI improvement at 4-weeks from baseline (mean change = 6.08, p = 0.005). Daily TENS therapy showed potential in reducing functional interference from pain, fatigue, and gait alterations in long-COVID individuals. The study’s limited power could affect the confirmation of certain observations. Extending the intervention period may improve treatment effectiveness.

Comparative Evaluation of Different Pain-alleviating Methods on Child's Dental Anxiety and Pain Perception during Local Anesthesia Administration: A Clinical Study.

When it comes to reducing children's fear, anxiety, and discomfort during dental procedures, substantial local anesthetic delivery promotes adequate intervention. In the dental operatory, local anesthetic injections are the most anticipated or feared stimuli. The application of topical anesthetics, cryotherapy, and transcutaneous electrical nerve stimulation (TENS) to the oral mucosa prior to local anesthetic injections can alter pain perception in children. To compare the efficacy of cryotherapy application, 2% benzocaine gel, and TENS therapy at reducing pain perception during local anesthesia (LA) administration in pediatric patients. In this randomized clinical trial, 75 pediatric patients between 4 and 8 years of age who needed LA for dental treatment were selected. They received cryotherapy (EXOCOOL) externally, 2% lignocaine topical gel (intraorally), or TENS therapy extraorally on the area of treatment. A pediatric dentist blinded to the study assessed Faces, Legs, Activity, Cry, and Consolability (FLACC) (subjective method), pulse rate, and SpO2, and patients were instructed to use a visual analog scale (VAS) to rate their distress during injection and Venham's Picture Test for anxiety assessment. Statistical analyses were performed using the Wilcoxon and Mann-Whitney U tests. The EXOCOOL group had significantly reduced pain scores on the VAS scale (3.80) when compared with the topical anesthetic gel group (4.08). The TENS group had reduced pain scores on the FLACC scale as well (2.84) when compared with the topical anesthetic gel group (3.72), which was statistically significant (p = 0.003). According to our study on pain and anxiety alleviation in children during LA administration, we found that TENS therapy demonstrated the highest effectiveness, surpassing both EXOCOOL and LA gel in providing relief. Goyal S, Patel M, Bhatt R, et al. Comparative Evaluation of Different Pain-alleviating Methods on Child's Dental Anxiety and Pain Perception during Local Anesthesia Administration: A Clinical Study. Int J Clin Pediatr Dent 2024;17(11):1265-1271.

Transcutaneous electrical nerve stimulation therapy in the management of temporomandibular joint disorders

A collection of illnesses known as temporomandibular joint disorders (TMD) impact the masticatory system, which includes the temporomandibular joint (TMJ) and the masticatory muscles, functionally. Transcutaneous electrical nerve stimulation (TENS) is one of several known aetiologies that have unique therapy options. A review of TENS use in TMD patient care is included in the current paper. Among the effective therapy modalities for treating TMD is transcutaneous electrical nerve stimulation. It involves carefully exposing the skin's surface to electrical current, which relaxes tense muscles and lessens discomfort.

Comparison And Evaluation Of Interferential Current Therapy And Transcutaneous Electrical Nerve Stimulation In Temporomandibular Joint Disorders: A Prospective Interventional Study

Aim: This study evaluated the effectiveness of transcutaneous electrical nerve stimulation (TENS) and interferential current therapy (IFT) to decrease jaw pain and muscle tenderness, improve maximum vertical mouth opening, and compare intra-operative patient comfort. Methodology: This comparative study was conducted in the outpatient oral and maxillofacial surgery department of the SRM Kattankulathur Dental College and Hospital. Twenty participants with chronic or recurrent jaw pain were randomly assigned to either Group A or Group B for the study. IFT and TENS were administered to Groups A and B. They were evaluated for intra-operative comfort, muscle tenderness, mouth opening, and pain over three treatment sessions. Results: Both groups showed improvement in pain, muscle tenderness, and mouth opening after three follow-up sessions. Compared to TENS, IFT significantly improved patient comfort (p<0.05). While there was no significant difference in pain and muscle tenderness reduction between the two groups at 5% significance level (p<0.05), IFT demonstrated slightly better improvement in vertical mouth opening. Conclusion: IFT is frequently employed to treat musculoskeletal disorders; however, its effectiveness in alleviating pain associated with temporomandibular disorders is still poorly understood. This study observed significant pain reduction in both IFT and TENS groups, along with a decrease in masticatory muscle and TMJ tenderness and improvement in mouth opening. Compared to TENS, IFT provided superior intra-operative comfort hence overcoming the drawback associated with TENS. These findings suggest that IFT may serve as an effective therapeutic option for temporomandibular disorder

Comparing the Efficacy of Transcutaneous Electric Nerve Stimulation (TENS) and Low Level Laser Therapy (LLLT) in the Management of Temporomandibular Joint Disorders: A Pilot Study

Comparing the Efficacy of Transcutaneous Electric Nerve Stimulation (TENS) and Low Level Laser Therapy (LLLT) in the Management of Temporomandibular Joint Disorders: A Pilot Study

Evaluation of the Effects of TENS Therapy and Acetaminophen on Pain Alleviation in Initial Orthodontic Treatment.

This prospective study aimed to evaluate the analgesic effects of acetaminophen and Transcutaneous Electric Nerve Stimulation (TENS) therapy for pain control. Forty orthodontic patients who underwent fixed orthodontic treatment were randomly assigned to one of 3 groups: (1) acetaminophen, (2) TENS therapy, or (3) control. Pain was evaluated at 12, 24, 36, and 48 hours after the placement of both 0.014" NiTi and 0.016" NiTi archwires using a 10 cm visual analogue scale (VAS). Because the data were found to be non-normal, Kruskal-Wallis test was employed for both stage I and stage II intra-group comparisons. For both stage I and stage II, evaluation of the VAS scores for all 3 groups at different time intervals showed that the difference between groups A and B was statistically insignificant (p>0.05). The scores of Group A compared to Group C were significant, and Group B compared to Group C showed significant values. Both TENS and acetaminophen reduced the pain experienced by patients compared with the placebo group. The acetaminophen group showed VAS results similar to those of the TENS group.

Effect of transcutaneous electrical nerve stimulation therapy on condylar position and myofascial pain in patients with temporomandibular joint disorders-A pilot clinical trial.

Temporomandibular joint disorders (TMD) are a type of disorder that affects the temporomandibular joint, muscles, and nerves leading to persistent facial pain. Transcutaneous electrical nerve stimulation (TENS) therapy is an alternative treatment for pain relief in TMD patients. The aim of the study was to assess the condylar position changes and pain levels occurring in TMD patients after TENS therapy. According to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) criteria, a total of seven patients with TMD were included in this study. Routine diagnostic investigations were taken for each patient along with joint vibration analysis (JVA), electromyography (EMG), and a cone beam computed tomography (CBCT) at rest position. Using the Dolphin software (version 11.95), the temporomandibular joint spaces were measured on the CBCT for the right and left sides individually for each patient. These patients were then subjected to TENS therapy, and an EMG reading was taken post-TENS therapy to evaluate the effect on muscle strain. A CBCT was taken after the TENS therapy to assess its effect on the condylar position. The statistical significance of the pre- and post-temporomandibular joint spaces and the EMG readings post-TENS therapy were assessed using paired t-tests, respectively. There was a change in the anterior, middle, and posterior dimensions observed radiographically, before and after TENS. However, the results were found to be statistically significant only in the anterior region on the right joint space (P = 0.03) and posterior region of the left joint space (P = 0.04). TENS therapy has been found to bring about a change in the condylar position and pain intensities by relieving inadvertent muscle activity in the temporomandibular region. Therefore, further studies with larger sample sizes and control are required to fully ascertain the role of inadvertent muscle activity on the TMJ.

Evaluation of The Efficacy of Therapeutic Ultrasound, Transcutaneous Electrical Nerve Stimulation and Low-Level Laser Therapy in the Management of Temporomandibular Disorders: A Comparative Study

Abstract Aim Temporomandibular disorders (TMDs), one of the most common causes of chronic orofacial pain is caused by the dysfunction of the various components of the temporomandibular joint and often require the use of non-invasive physical therapeutic modalities for its management. The present study was undertaken to compare the efficacy of plain therapeutic ultrasound (Th US), transcutaneous electric nerve stimulation (TENS therapy) and low-level laser therapy (LLLT) in the management of TMD. Materials and methods In this randomized clinical trial, 45 subjects aged between 18 to 40 years and diagnosed with TMD were randomly divided into three groups. The subjects of group A, group B and group C were treated with Th US, TENS therapy and LLLT, respectively, twice a week for a period of two weeks. The efficacy of each modality was evaluated in terms of pain intensity and functional improvement of the subjects both prior to and after each session using Visual Analogue Scale (VAS), Helkimo dysfunctional clinical index (HI) and Maximum Mouth Opening (MMO). Inter-group and multi-group comparisons of all the parameters, along with age-based differences, were analyzed using SPSS software (version 26) and a p-value of 0.05 was considered to be statistically significant. Results The mean age of the included study subjects were 30.3 ± 9.1, 27.5 ± 6.7 and 27.4 ± 6 years in the Th US, TENS therapy and LLLT respectively, with a female predominance (53.3%). A significant reduction of pain intensity (VAS) and dysfunction (HI), along with improvement of mouth opening (MMO), was seen among the subjects of all three groups by the end of the last interventional session (p < 0.05). However, a maximum difference was noted among the subjects of group C (LLLT) in terms of inter-group and multi-group comparisons of VAS, HI and MMO, followed by group A (Th US) and group B (TENS), respectively. Though the recurrence rate was high among the subjects of group Β (26.6%), there was no statistical significance. Conclusion Although significant improvements were observed among all three study groups, LLLT established a superiority over Th US and TENS therapy in terms of pain relief, mouth opening as well as functional outcome of the joint. Based on our results, we suggest the application of LLLT as an effective interventional option for TMD patients to achieve better and long-lasting functional results.

Fibromyalgia Diagnosis and Treatment Receipt in the U.S. Military Health System.

Meta-analytic findings and clinical practice guidance recommend pharmacological (e.g., pregabalin, duloxetine, and milnacipran) and non-pharmacological (e.g., exercise and sleep hygiene) interventions to reduce symptoms and improve quality of life in people living with fibromyalgia. However, some of these therapies may lack robust evidence as to their efficacy, have side effects that may outweigh benefits, or carry risks. Although the annual prevalence of fibromyalgia in active duty service members was estimated to be 0.015% in 2018, the likelihood of receiving a fibromyalgia diagnosis was 9 times greater in patients assigned female than male and twice as common in non-Hispanic Black than White service members. Therefore, the primary goal of this retrospective study is to examine co-occurring conditions and pain-management care receipt in the 3 months before and 3 months after fibromyalgia diagnosis in active duty service members from 2015 to 2022. Medical record information from active duty service members who received a fibromyalgia diagnosis between 2015 and 2022 in the U.S. Military Health System was included in the analyses. Bivariate analyses evaluated inequities in co-occurring diagnoses (abdominal and pelvic pain, insomnia, psychiatric conditions, and migraines), health care (acupuncture and dry needling, biofeedback and other muscle relaxation, chiropractic and osteopathic treatments, exercise classes and activities, massage therapy, behavioral health care, other physical interventions, physical therapy, self-care management, and transcutaneous electrical nerve stimulation), and prescription receipt (anxiolytics, gabapentinoids, muscle relaxants, non-opioid pain medication, opioids, selective serotonin and norepinephrine inhibitors, and tramadol) across race and ethnicity and assigned sex. Pairwise comparisons were made using a false discovery rate adjusted P value. Overall, 13,663 service members received a fibromyalgia diagnosis during the study period. Approximately 52% received a follow-up visit within 3 months of index diagnosis. Most service members received a co-occurring psychiatric diagnosis (35%), followed by insomnia (24%), migraines (20%), and abdominal and pelvic pain diagnoses (19%) fibromyalgia diagnosis. At least half received exercise classes and activities (52%), behavioral health care (52%), or physical therapy (50%). Less commonly received therapies included other physical interventions (41%), chiropractic/osteopathic care (40%), massage therapy (40%), transcutaneous electrical nerve stimulation (33%), self-care education (29%), biofeedback and other muscle relaxation therapies (22%), and acupuncture or dry needling (14%). The most common prescriptions received were non-opioid pain medications (72%), followed by muscle relaxers (44%), opioids (32%), anxiolytics (31%), gabapentinoids (26%), serotonin-norepinephrine reuptake inhibitor (21%), selective serotonin reuptake inhibitors (20%), and tramadol (15%). There were many inequities identified across outcomes. Overall, service members diagnosed with fibromyalgia received variable guideline-congruent health care within the 3 months before and after fibromyalgia diagnosis. Almost 1 in 3 service members received an opioid prescription, which has been explicitly recommended against use in guidelines. Pairwise comparisons indicated unwarranted variation across assigned sex and race and ethnicity in both co-occurring health conditions and care receipt. Underlying reasons for health and health care inequities can be multisourced and modifiable. It is unclear whether the U.S. Military Health System has consolidated patient resources to support patients living with fibromyalgia and if so, the extent to which such resources are accessible and known to patients and their clinicians.

The role of TENS therapy in reducing the incidence of post-Caesarean section wound infection.

The occurrence of wound infection following a Caesarean section procedure poses a substantial clinical obstacle. Transcutaneous Electrical Nerve Stimulation (TENS) has been identified as a promising supplementary treatment option for improving the healing process and decreasing the incidence of infections. This study assessed the efficacy of TENS therapy in the postoperative care of patients who have had Caesarean section. We randomly assigned a total of 108 women who had Caesarean sections to either a TENS group (n = 54) or control (n = 54). The TENS therapy was provided twice daily for a duration of 30 min for the period of 14 days following the surgery. The main measure of interest in this study was the occurrence of wound infection during 30-day period. Additionally, secondary measures included the rate of wound healing, levels of pain experienced and level of patient satisfaction. In comparison to the control (22.2%, p < 0.05), the TENS group had notably reduced occurrence of wound infection, with the rate of 7.4%. TENS group had superior wound healing results, as measured by REEDA scale, at 7 days (2.1 ± 0.8 vs. 2.5 ± 1.0, p < 0.04), 14 days (1.2 ± 0.5 vs. 1.9 ± 0.7, p < 0.05) and 30 days (0.3 ± 0.5 vs. 0.7 ± 0.6, p < 0.05). Furthermore, TENS group had reduced pain levels on the Visual Analog Scale (VAS) at all evaluation intervals (p < 0.05). TENS group exhibited significantly higher levels of patient satisfaction, as evidenced by 64.8% of participants rating high satisfaction, in contrast to 40.7% in the control group (p < 0.05). The incidence of adverse effects was found to be minor, as indicated by a skin irritation rate of 3.7% and reported discomfort rate of 1.9% at the electrode location. TENS therapy effectively decreased the occurrence of post-Caesarean wound infections, expedited the healing process and enhanced pain control. This treatment was well-received by patients and had little negative consequences. The aforementioned results provided evidence in favour of incorporating TENS into post-Caesarean care regimens, which may have significant consequences for improving patient outcomes and maximizing healthcare resources.

Role of electrical stimulation on constipation among young children: Systematic review

Abstract: INTRODUCTION: Constipation frequently has multiple causes and could be an indication of an underlying medical illness. In addition, lesions or anatomical abnormalities within the colon may be the cause of constipation. Numerous therapeutic approaches, including physiotherapy methods, abdominal massage, electrical stimulation, biofeedback, exercise, connective tissue manipulation, and Kinesio Taping, are effective in treating constipation in children. Transcutaneous electrical nerve stimulation (TENS), a non-invasive, safe, and simple-to-use interference current used to stimulate nerves, is one of the most widely utilized methods. Transcutaneous electrical stimulation enhanced the frequency of defecation and decreased soiling in children. METHODOLOGY: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were formed for this review. The following electronic databases were explored for the review and experimental study that took place between 2004 and 2024: Search engines such as Google Scholar, PubMed, Cochrane library, Scopus, Cinahl, and the WoS. RESULTS: Before being submitted to the Rayyan website for selection, the records that were obtained were analyzed by Zotero. Initially, 160 articles were screened for the study out of which only n = 6 articles were included in the after screening on the basis of eligibility criteria. CONCLUSION: It has been concluded that electrical stimulations such as TENS and interferential therapy have a beneficial effect in treating constipation among children of the age group of 2–18 years.

Efficacy of TENS Therapy, Therapeutic Ultrasound and Stabilization Splint as an Adjuvant to Pharmacotherapy for Temporomandibular Disorders

INTRODUCTIONThis study aims to assess the effectiveness of adjunctive treatments like transcutaneous electric nerve stimulation (TENS), therapeutic ultrasound (ThUs), and stabilization splint (SS) in combination with pharmacotherapy (PT) in enhancing pain relief, mouth opening, lateral excursion, joint sound reduction, muscle tenderness improvement, and jaw deflection in patients with temporomandibular disorders (TMDs), affecting the temporomandibular joint and masticatory muscles. MATERIAL AND METHODSThe study involved 90 patients divided into three groups. Pharmacotherapy (Tab. Myospaz) was prescribed to all patients, each group received either TENS, ThUs, or SS as adjunctive treatment. Outcomes were measured at baseline and various intervals post-treatment. RESULTSTMDs were more prevalent in younger age group (21-30 years) with female predilection (F:M =2.21:1). Significant differences were observed in pain scores, with TENS and ThUs groups showing greater reductions compared to SS. ThUs demonstrated superior results in mouth opening, while TENS showed better outcomes in lateral excursion and muscle tenderness reduction. CONCLUSIONThis study concluded that both TENS and therapeutic ultrasound effectively reduced pain with therapeutic ultrasound showing better results in improving mouth opening, and TENS demonstrating better results in lateral excursion and muscle tenderness reduction. No significant difference among three groups were found in reducing joint sounds and deviation/deflection.

Low-Level Laser and TENS Therapy Assessment for the Treatment of Temporomandibular Joint Disorder.

The most prevalent conditions in the population are temporomandibular disorders (TMDs), which are linked to a number of morbidities. A number of treatment options have been proposed, and some of the most successful ones include low-level laser therapy (LLLT) and transcutaneous electrical nerve stimulation (TENS) therapy. The purpose of this study was to examine the effectiveness of two therapies-TENS treatment and LLLT-in the management of morbidities related to temporomandibular joint (TMJ) disorders. Based on inclusion and exclusion criteria, a total of 50 patients who had been sent to the oral medicine outpatient department and had been pre-diagnosed with TMJ disorders were randomly assigned to two groups, with 25 patients in each: Group I received TENS therapy, while Group II received LLLT. The acquired data was assessed statistically. Both groups showed a substantial decrease in discomfort, an increase in mouth opening, and a decrease in muscular tenderness when compared to within groups. LLT was more effective than TENS for TMD treatment. While TENS and LLLT both had good results, LLLT appeared to outperform TENS therapy in terms of muscle tenderness factors.

Comparative Efficacy of Non-Invasive Therapies in Temporomandibular Joint Dysfunction: A Systematic Review.

Temporomandibular disorder (TMD) is a multifaceted disorder impacting the temporomandibular joint (TMJ), causing substantial discomfort and functional limitations. This systematic review aims to comprehensively assess the effectiveness of non-invasive treatment modalities for TMJ dysfunction, prioritizing a definitive protocol to ensure patient safety and enhance quality of life. Employing the PRISMA guidelines, we meticulously analyzed 20 studies from a pool of 1,417 articles sourced from databases such as PubMed, Google Scholar, ScienceDirect, and Medline. These studies underscore the multifarious nature of TMD and the varied responses to treatments such as physical therapy, laser therapy, ultrasound and electrical stimulation, splint therapy, injections, and arthrocentesis. Notably, the review highlights the paramount importance of precise diagnosis, often through surface electromyography, followed by a tailored treatment approach integrating manual therapy, counseling, and splint therapy. The systematic analysis revealed that while certain treatments such as transcutaneous electrical nerve stimulation and low-level laser therapy showed limited efficacy, combination therapies, especially those involving manual therapy, counseling, and splint therapy, demonstrated substantial improvement in reducing pain, depression, and anxiety. The findings advocate for a non-invasive, patient-centric approach, emphasizing education and symptom management before considering more invasive procedures such as injections and arthrocentesis. The review identifies the need for more comprehensive, longitudinal studies to establish a standardized, evidence-based treatment protocol for TMJ dysfunction, aiming to improve patient outcomes holistically.

Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy in children with cerebral palsy with lower urinary system dysfunction- a randomized prospective trial

Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP have achieved urinary control, more than 50% of cases experience lower urinary tract symptoms (LUTS). Common LUTS complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections. This study aimed to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, sacral Transcutaneous Electrical Nerve Stimulation (TENS) and massage, on lower urinary tract dysfunction in children with CP. A total of 54 children with CP who had the Dysfunctional Voiding Scoring System (DVISS) of 8.5 or higher were included in the study. Children were randomized to the TENS (TG; n=27) and Manual Therapy (MG; n=27) groups. TENS application was performed 2 sessions in a week for 20min for a total of 12 weeks. The electrodes used during the application were adhered bilaterally to the parasacral region (S2-S4). 4 electrodes of 5×5cm were used. Classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Manual therapy applications were performed in the form of abdominal, colon, and friction massage, twice a week for 20min by the physiotherapist. Massage was applied to the abdominal region between the lower subcostal border and the anterior superior iliac spine. Questionnaires were applied before and after treatment interventions: DVISS, functional bladder capacity (FBC), frequency of voiding, and urinary incontinence episodes evaluated by bladder diary, Bristol Gaita Scale, and Pediatric Incontinence Quality of Life Scale (PIN-Q) used. The decrease in the episodes of incontinence was higher in the TG (p=0.037; p<0.05). FBC increased after treatment in both groups, but there was no statistically significant difference between the groups (p=0.683; p>0.05). Manual therapy was more effective in improving constipation symptoms. In both groups, DVISS and PIN-Q values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p=0.001; p<0.01). Both parasacral TENS and massage provided a significant improvement in LUTS, constipation, and quality of life but TENS showed a bigger improvement. We suggest adding these interventions to the treatment of bladder and bowel problems in CP children.

Evaluation of Pain Perception During Orthodontic Debonding of Metallic Brackets with Simultaneous Application of TENS Therapy.

The objective of the present study was to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on pain during the debonding procedure. A placebo-controlled, randomized split - mouth study was conducted on 30 orthodontic patients. The right and left anterior teeth in the maxilla and mandible were randomly allocated to the control and experimental groups (EG) and were stimulated. TENS application was made through a modified electrode probe that was used from an ammeter. The control group (CG) received the mechanical application of the device with no current, whereas the EG received progressively increasing current from 0.1 mA to the point where the patient experienced a mild tingling sensation for 60 s for each tooth. This was followed by a debonding procedure using an orthodontic debonding plier. Pain perception was recorded on a numerical rating scale after debonding each tooth. The mean pain score was higher in the CG than in the EG, and the difference between the two groups was significant (p=0.001). The pain score was higher in the mandibular teeth than in the maxillary teeth, and the difference between the two groups was also significant (p=0.021). Pain score was higher in female subjects than in male subjects, and the difference between the two groups was significant (p=0.015). The application of TENS therapy results in pain reduction during the debonding procedure. The female subjects experienced more pain. Higher pain scores were recorded for the mandibular anterior teeth than for the maxillary teeth.

PERINEURAL INJECTION THERAPY AS INTERVENTIONAL PAIN MANAGEMENT IN POST HERPETIC NEURALGIA : A CASE REPORT

Introduction: Post Herpetic Neuralgia is a neurological complication of herpes zoster resulting in neuropathic pain syndrome that worsens as a direct result of peripheral nerve damage that occurs during an attack of herpes zoster. It manifests as significant dermatomal pain or abnormal sensations and impacting various aspects of quality of life. Physically, patients may experience fatigue, anorexia, weight loss, insomnia, reduced mobility, and physical inactivity. Psychologically, it can lead to depression, anxiety, emotional burden, difficulty in concentration, and fear. Perineural Injection Therapy (PIT), developed by John Lyftogt, offers a treatment option for chronic neuropathic pain. Case Report: A 65-year-old male, currently unemployed for the past two years and previously worked as a tire repairman, came to the Husada Asih Clinic, with sharp, not radiating, and continuous left facial pain (VAS 9-10). He received treatment comprising Transcutaneous Electrical Nerve Stimulation (TENS) and Low Laser Light Therapy (LLLT) on the left face, combined with PIT injections using 5% dextrose at the left side of the face, targeting dermatomes left N V.1, V.2, V.3, and C3 , with repetition after three weeks. After the third injection, the pain at his left head was reduced (VAS 6). Pain at his left jaw and left neck reduced and became intermittently (VAS 5). Barthel Index : 20/20 (Independent). Discussion: The immediate clinical improvement in PIT administration is attributed to the sensorineural effects of dextrose. Clinically, pain decreases immediately or within 1-2 days after therapy. In this case, three series PIT resulted in significant pain relief, reduced burning sensation, improved left muscle motor function, full mouth opening, eased in eating and speaking, and the ability to resume social activities and work. Conclusion: Perineural injection therapy (PIT), previously developed by John Lyftogt, involves a series of subcutaneous injections using 5% dextrose in sterile water (D5W) near the affected nerve. This regenerative therapy offers pain control for PHN patients by targeting skin nerves as potential pain generators. PIT proves to be a valuable rehabilitation tool for managing PHN.

Transcutaneous electrical nerve stimulation in the management of restless legs syndrome symptoms: A single-blind, parallel-group clinical study.

The aim of this study was to investigate the additional effect of transcutaneous electrical nerve stimulation (TENS) on the control of the symptoms of restless legs syndrome (RLS). A total of 46 randomly selected patients diagnosed with RLS were divided into two groups in a single-blind study to either receive pramipexole (0.25 mg daily) plus 10 sessions of TENS or only pramipexole (0.25 mg daily) for 4 weeks. The severity of the symptoms was determined according to the International Restless Legs Syndrome Rating Scale (IRLSRS) and the Pittsburgh sleep quality index (PSQI) at the beginning of the treatment, post-treatment, and at an 8 week follow-up. A significant time interaction was observed between the groups for all measurement outcomes, revealing differences in favour of the experimental group's IRLSRS and PSQI scores. A notable improvement was also observed in the IRLSRS and PSQI scores in both groups at the end of treatment and during the 8 week follow-up period. In comparison with pramipexole monotherapy, the results of this study showed that the use of TENS therapy combined with a low dose of pramipexole (0.25 mg daily) is therapeutically beneficial in the treatment of RLS over an 8 week follow-up period.