Effect of progressive muscular relaxation exercises versus transcutaneous electrical nerve stimulation on tension headache: A comparative study

Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research

Background and Objectives: Characterising the features of methodologies, clinical attributes and intervention protocols, of studies is valuable to advise directions for research and practice. This article reports the findings of a secondary analysis of the features from studies screened as part of a large systematic review of TENS (the meta-TENS study). Materials and Methods: A descriptive analysis was performed on information associated with methodology, sample populations and intervention protocols from 381 randomised controlled trials (24,532 participants) evaluating TENS delivered at a strong comfortable intensity at the painful site in adults with pain, irrespective of diagnosis. Results: Studies were conducted in 43 countries commonly using parallel group design (n = 334) and one comparator group (n = 231). Mean ± standard deviation (SD) study sample size (64.05 ± 58.29 participants) and TENS group size (27.67 ± 21.90 participants) were small, with only 13 of 381 studies having 100 participants or more in the TENS group. Most TENS interventions were ‘high frequency’ (>10 pps, n = 276) and using 100 Hz (109/353 reports that stated a pulse frequency value). Of 476 comparator groups, 54.2% were active treatments (i.e., analgesic medication(s), exercise, manual therapies and electrophysical agents). Of 202 placebo comparator groups, 155 used a TENS device that did not deliver currents. At least 216 of 383 study groups were able to access other treatments whilst receiving TENS. Only 136 out of 381 reports included a statement about adverse events. Conclusions: Clinical studies on TENS are dominated by small parallel group evaluations of high frequency TENS that are often contaminated by concurrent treatment(s). Study reports tended focus on physiological and clinical implications rather than the veracity of methodology and findings. Previously published criteria for designing and reporting TENS studies were neglected and this should be corrected in future research using insights gleaned from this analysis.

Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache. A systematic review and network meta-analysis

BACKGROUND

This systematic review assesses the effectiveness of physiotherapy on headache parameters and quality of life of patients with tension-type headache using network meta-analysis.

METHODS

A systematic search was conducted in the databases Web of Science, Medline, Cochrane Library and Physiotherapy Evidence Database up to August 2021. Randomised controlled trials investigating the effect of physiotherapy on tension-type headache were included. Risk of bias assessment was performed using the Risk of bias tool 2.0. Results were presented according to the Cochrane handbook and the PRISMA statement.

RESULTS

Twenty reports were eligible and 15 were included in network meta-analysis for pain intensity and frequency. Transcutaneous electrical stimulation combined with physiotherapy was the most effective approach to reduce pain intensity compared to control (mean difference (MD): -4.18, moderate confidence) and usual care (MD: -3.8, moderate confidence) Manual therapy (joint mobilisation) plus exercise was the most effective intervention to reduce headache frequency compared to control (MD: -13.03, low confidence) and usual care (MD: -13.95, moderate confidence).

CONCLUSION

Results suggest a combination of passive physiotherapy techniques with exercise and/or transcutaneous electrical stimulation as the most effective physiotherapy intervention to reduce pain intensity and frequency in the short term. More research is needed to investigate mid-term and long-term effects.Trial registration: This review was prospectively registered in www.aspredicted.org under the registration number #46098 and an updated protocol was registered in the Open Science Framework (OSF) with the registration DOI: https://doi.org/10.17605/OSF.IO/RVUEY.

Características perilaríngeas y semiológicas de mujeres con odinofonía

El objetivo de este estudio es analizar las características perilaríngeas y semiológicas de mujeres con odinofonía. Mediante el uso de algometría de presión, de una escala numérica y de una encuesta sometida a procesos de validación y de consistencia interna, se trabajó con 40 participantes de sexo femenino. Se formaron dos grupos de 20 sujetos cada uno (G1 o asintomático y G2 o con odinofonía). Los umbrales de presión de G1 se encontraron entre los 1000 y 2700 gramos, mientras que los de G2 fluctuaron entre los 500 y 2000 gramos (p = 0.000). El 60 % de las participantes indicó que el lugar de menor umbral de presión es donde siente habitualmente el dolor durante la fonación. A su vez, se observó que la odinofonía es una condición que mejora con el descanso, se acompaña principalmente de sensación de irritación y de picazón del tracto vocal, su localización tiende a ser precisa y ocasionalmente afecta a la deglución. Por último, se observó que la intensidad habitual de la odinofonía es moderada. En conclusión, la odinofonía se trata de una condición que se produce con la sobrecarga vocal y se acompaña de aumento en la sensibilidad perilaríngea. Las mujeres con odinofonía presentan características semiológicas y psicosociales específicas para su condición.

Rol de los agentes físicos en la rehabilitación vocal: una revisión de la literatura

Los agentes físicos son elementos naturales o artificiales que se aplican para el tratamiento de determinados síntomas o patologías. En la rehabilitación vocal su estudio es un área emergente, donde las revisiones sistemáticas y los meta-análisis son escasos. Esto, muchas veces, dificulta la toma de decisiones y la correcta elección por parte del clínico.  El objetivo de este trabajo fue analizar el rol de los agentes físicos en la rehabilitación vocal. Se realizó una revisión de la literatura a través de la búsqueda de artículos en las bases de datos PubMed, EBSCOHost y Scielo. Se establecieron criterios de elegibilidad según tipo, año y características de los estudios. Se evaluaron 603 artículos, de los cuales, luego del análisis de su título, abstract y del cumplimiento de los criterios de elegibilidad, se seleccionaron 16. Se entregan resultados en base a la cantidad de participantes, nivel de evidencia, tipo y configuración del agente físico, procedimientos e instrumentos de evaluación y beneficios obtenidos. Los agentes físicos de mayor utilización en la clínica vocal son la electroterapia (TENS y NMES) y la laserterapia. En general, estos actúan como coadyuvantes en la terapia vocal. La TENS reduce el dolor, la tensión laríngea y la percepción de voz apretada durante la fonación. La NMES beneficia la activación neuromuscular de las cuerdas vocales y el uso de láser permite la recuperación de los tejidos laríngeos posterior a tareas de sobrecarga.

Transcutaneous electrical nerve stimulation for acute pain

BACKGROUND

This is a second update of a Cochrane Review originally published in Issue 2, 2009. Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological agent, based on delivering low voltage electrical currents to the skin. TENS is used by people to treat a variety of pain conditions.

OBJECTIVES

To assess the analgesic effectiveness of TENS, as a sole treatment, for acute pain in adults.

SEARCH METHODS

We searched the following databases up to 3 December 2014: the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; EMBASE; CINAHL; and AMED. We also checked the reference lists of included trials.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of adults with acute pain (< 12 weeks) if they examined TENS given as a sole treatment and assessed pain with subjective pain scales. Trials were eligible if they compared TENS to placebo TENS, no treatment controls, pharmacological interventions or non-pharmacological interventions. We excluded trials on experimental pain, case reports, clinical observations, letters, abstracts or reviews. Also we excluded trials investigating the effect of TENS on pain during childbirth (labour), primary dysmenorrhoea or dental procedures. Studies where TENS was given with another treatment as part of the formal trial design were excluded. We did not restrict any articles based on language of publication.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study eligibility and carried out study selection, data extraction, 'Risk of bias' assessment and analyses of data. We extracted data on the following: types of participants and pain condition, trial design and methods, treatment parameters, adverse effects, and outcome measures. We contacted trial authors for additional information if necessary.

MAIN RESULTS

We included 12 trials in the original review (2009) and included no further trials in the first update (2011). An additional seven new trials met the inclusion criteria in this second update. In total, we included 19 RCTs involving 1346 participants at entry, with 11 trials awaiting classification either because the full text was unavailable or information in the full text failed to clarify eligibility. We excluded most trials because TENS was given in combination with another treatment as part of the formal study design or TENS was not delivered using appropriate TENS technique. The types of acute pain included in this Cochrane Review were procedural pain, e.g. cervical laser treatment, venepuncture, screening flexible sigmoidoscopy and non-procedural pain, e.g. postpartum uterine contractions and rib fractures. We pooled data for pain intensity for six trials (seven comparisons) comparing TENS with placebo but the I(2) statistic suggested substantial heterogeneity. Mean difference (MD) with 95% confidence intervals (CIs) on a visual analogue scale (VAS, 100 mm) was -24.62 mm (95% CI -31.79 to -17.46) in favour of TENS. Data for the proportion of participants achieving ≥ 50% reduction in pain was pooled for four trials (seven comparisons) and relative risk was 3.91 (95% CI 2.42 to 6.32) in favour of TENS over placebo. We pooled data for pain intensity from five trials (seven comparisons) but the I(2) statistic suggested considerable heterogeneity. MD was -19.05 mm (95% CI -27.30 to -10.79) in favour of TENS using a random-effects model. It was not possible to pool other data. There was a high risk of bias associated with inadequate sample sizes in treatment arms and unsuccessful blinding of treatment interventions. Seven trials reported minor adverse effects, such as mild erythema and itching underneath the electrodes and participants disliking TENS sensation.

AUTHORS' CONCLUSIONS

This Cochrane Review update includes seven new trials, in addition to the 12 trials reviewed in the first update in 2011. The analysis provides tentative evidence that TENS reduces pain intensity over and above that seen with placebo (no current) TENS when administered as a stand-alone treatment for acute pain in adults. The high risk of bias associated with inadequate sample sizes in treatment arms and unsuccessful blinding of treatment interventions makes definitive conclusions impossible. There was incomplete reporting of treatment in many reports making replication of trials impossible.