Comparison of the effects of transcutaneous electrical nerve stimulation and low-level laser therapy on drug-resistant temporomandibular disorders

Statement of the Problem: Temporomandibular disorder [TMD] is a clinical term used for clinical signs and symptoms that affect the temporomandibular joints, masticatory muscles, and associated structures. Surgical and non-surgical treatments can be used for management of TMD. Non-surgical route is the main part of the treatment, since clinicians prefer non-aggressive treatment for TMD such as pharmacological and physical therapy. Low-level laser therapy [LLLT] and transcutaneous electrical nerve stimulation [TENS] are the main procedures in physical therapy

Purpose: The aim of this study was to evaluate the effectiveness of TENS and LLLT in treatment of TMD patients who did not respond to pharmacological therapy

Materials and Method: This clinical trial was performed on 45 patients who randomly received either TENS or LLLT for 8 sessions. LLLT was applied with diode laser [Ga-Al-As, 980nm, dose 5micro/cm[2]] and TENS by using two carbon electrodes with 75 Hz frequency [0.75 msec pulse width]

Helkimo index and visual analogue scale [VAS] were measured during the treatment period and throughout the follow-up sessions

Results: Significant reduction in the VAS and Helkimo index was observed in both TENS and LLLT group. There was no significant difference between the two methods during the treatment; however, TENS was more effective in pain reduction in follow-ups

Conclusion: This study justified the use of TENS therapy as well as LLLT in drug-resistant TMD. Both were useful in relieving the pain and muscles tenderness, although, TENS was more effective than LLLT

Propriedades clinimétricas da variável eletromiográfica duty factor para desordem temporomandibular / Clinimetric properties of duty factor for temporomandibular disorder

Objetivo Avaliar a confiabilidade e responsividade do duty factor à dor provinda da desordem temporomandibular Métodos Participaram 20 voluntárias, com média de idade de 29 anos e 6 meses (±9,2), portadoras de desordem temporomandibular miogênica, segundo o critério diagnóstico para pesquisa em Desordem Temporomandibular (RDC/TMD). Foram coletados sinais eletromiográficos nas condições de repouso dos músculos mastigatórios, na presença de dor moderada a severa e na diminuição ou eliminação desta dor após aplicação de Estimulação Elétrica Nervosa Transcutânea durante 45 minutos. Os sinais eletromiográficos de repouso foram processados para obtenção dos valores do tempo de ativação muscular acima de 10% do valor da máxima força de apertamento dentário. A confiabilidade foi testada pelo coeficiente de correlação intraclasse em dados repetidos antes da analgesia. Também foi calculado o erro padrão de medida e mínima mudança detectável. A responsividade da variável foi analisada entre as coletas eletromiográficas realizadas antes e após a analgesia pelo tamanho de efeito e média de resposta padronizada. Resultados Duty factor apresentou valores de coeficiente de correlação intraclasse acima de 0,75 para todos os músculos. O erro padrão foi entre 4% e 8% e a mínima mudança detectável entre 5% e 12%. Na responsividade da variável para a dor, o tamanho de efeito obteve valores entre 0,2 e 0,5 e a média da resposta padronizada, valores acima de 0,8. Conclusão O duty factor apresentou confiabilidade excelente e responsividade à dor da desordem temporomandibular baixa para tamanho de efeito e excelente para média da resposta padronizada. .

Purpose To assess the reliability and responsiveness of the duty factor variable for assessing pain originating from temporomandibular disorders. Methods The sample comprised 20 female volunteers, mean age 29 years 6 months (± 9.2), with a diagnosis of myogenic temporomandibular dysfunction according to the Research Diagnostic Criteria for Temporomandibular Disorders. Electromyographic (EMG) signals were collected at three times: during mandibular rest; in the presence of moderate to severe pain; and when pain was reduced to mild or absent after 45 minutes of transcutaneous electrical nerve stimulation (TENS). Electromyographic signals during mandibular rest were processed to obtain values for muscle activation time greater than 10% of maximum bite force. Reliability was tested with intraclass correlation for repeated data before analgesia. Standard error of measurement (SEM) and minimum detectable change (MDC) were also computed to determine reliability. Responsiveness of duty factor was analyzed between EMG recordings, before and after analgesia, by calculating effect size (ES) and standardized response mean (SRM). Results Duty factor presented intraclass correlation coefficient above 0.75 for all muscles. Standard error of measurement ranged from 4% to 8% and minimum detectable change from 5% to 12%. Regarding the responsiveness of duty factor to pain, effect size values fell between 0.2 and 0.5 and SRM values were greater than 0.8. Conclusion Duty factor showed excellent reliability. However, responsiveness to TMD-related pain was low as expressed by effect size and excellent as expressed by standardized response mean. .

Intravenous lidocaine for refractory chronic orofacial pain: Two case reports and a literature review

This report presents the results of treatment of two adults, at the Pain Center of Montreal General Hospital, Canada, with intravenous lidocaine for intractable orofacial pain. Repeated lidocaine infusions [1mg/kg in a bolus, followed by 4mg/kg infused over 1 hour] resulted in satisfactory pain relief in both patients, and the drug was well tolerated. Intravenous lidocaine therapy may be considered for intractable orofacial pain; further research is warranted

Nuestra experiencia en cirugía con analgesia inducida por electroestimulación / Our experience in surgery with analgesia induced by electrical stimulation

Se analiza el protocolo de 24 pacientes intervenidos por patología urológica, biliar, mamaria, tiroidea, traumatológica, ginecológica yde paredes abdominales, a quienes se les efectuó analgesia inducida por electroestimulación. El 25,8% de los operados tenía más de 65 años y 2 tercios del total tenían riesgo quirúrgico elevado. El 70,8% de los casos presentaba 3 ó más enfermedades asociadas a la patología que motivó la consulta, predominando las alteraciones cardiovasculares y los pacientes ansiosos. En el preoperatorio se determinó el umbral y tolerancia al dolor registrándose con la estimulación eléctrica un aumento de 2 mAmp con respecto a los niveles basales. La analgesia comenzó a los 24,8 minutos promedio y persistió hasta los 8l,25 luego de terminada la operación. En el intraoperatorio se valoró el dolor en forma objetiva y subjetiva. El cirujano evaluó como bueno el grado de relajación muscular y se observó menos sangrado que con anestesia general. No hubo modificación de la frecuencia cardíaca, tensión arterial y registros electrocardiográficos. No se presentaron complicaciones en el postoperatorio inmediato y alejado.