Effectiveness of physical therapy interventions in women with dyspareunia: a systematic review and meta-analysis

BACKGROUND

Dyspareunia is defined as the occurrence of pain during or after sexual intercourse, which directly affects physical, sexual, and mental health. This condition can lead to depression, anxiety, and low self-esteem in women who experience it.

OBJECTIVES

The aim of this research was to evaluate the effectiveness of physical therapy interventions for the treatment of female dyspareunia.

DESIGN

A systematic review and meta-analysis was conducted.

METHOD

Search of publications was conducted in Scopus, Medline, Pubmed, Cinahl and Web of Science. Treatment effects were defined as standardized mean difference and their 95% confidence intervals. Statistical heterogeneity was assessed using Crohan's Q test and quantified using the I2 index.

RESULTS

Of the 19 articles selected, six applied multimodal physiotherapy treatments; five, electrotherapy; three, Thiele's massage; two, interdisciplinary interventions or pelvic floor muscle training; and one, extracorporeal shockwave therapy. The meta-analysis showed significant results for the variables pain and quality of life with the interventions based on electrotherapy and electrotherapy combined with pelvic floor muscle training. These interventions did not show significant results for the improvement of sexual function.

CONCLUSIONS

Physiotherapy techniques are effective and procedures have been identified with reliable results in improving pain and quality of life in patients with dyspareunia. One of the most important aspects is the strengthening of the perineal musculature and the application of Transcutaneous Electrical Nerve Stimulation. Furthermore, manual trigger point release therapy and Thiele massage, optimize and guarantee the reduction of pain intensity.

PROSPERO REGISTRATION

CRD42021236155.

Efficacy of percutaneous electrolysis for the treatment of tendinopathies: A systematic review and meta-analysis

OBJECTIVE

To evaluate the efficacy of percutaneous electrolysis for the treatment of patients with tendinopathies.

DATA SOURCES

A systematic search of publications was conducted in Pubmed, Cinahl, Medline, Scopus and Web of Science.

METHODS

The Oxford 2011 Levels of Evidence and the Jadad scale were used to assess the quality of studies. The mean and standard deviation were obtained for each study group and used to calculate the effect size. The DerSimonian and Laird method was used to develop a random-effects model.

RESULTS

Of the 14 articles, four applied percutaneous electrolysis to the knee, three to the shoulder, three to the elbow, two to the hip and two to the ankle and foot. A meta-analysis on intensity of pain (evaluated with algometer and the Visual Analogue Scale) was performed on studies comparing percutaneous electrolysis with a control group, indicating that the groups treated with percutaneous electrolysis had better results (p = 0.01). Although percutaneous electrolysis did not overcome the analgesic effect achieved by corticosteroid injections.

CONCLUSIONS

The percutaneous electrolysis is effective for the treatment of tendinopathies. The combination of this technique with eccentric training has proven to be one of the most effective treatments to date for improving pain. PROSPERO Registration: CRD42021230005.

Does electrode placement influence tens-induced antihyperalgesia in experimental inflammatory pain model?

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This study challenges the notion that TENS can only be applied at the site of pain.

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The study supports the use of TENS in patients with significant skin injuries.

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This helps to understand the action of TENS in edema.

Background

Transcutaneous electrical nerve stimulation (TENS) is a treatment commonly used for managing pain; however, the ideal placement of the electrodes is not fully understood.

Objective

To investigate the best way to apply TENS electrodes in an experimental inflammatory pain model.

Method

Knee joint inflammation was induced in rats, followed by administration of low-frequency TENS (4 Hz) under anesthesia for five days. Animals were randomly allocated to five groups according to electrode placement (n = 6, each): dermatome, contralateral, paraspinal, acupoint, and control. Interventions: Low-frequency TENS at sensory intensity and 100 μs pulse duration. Withdrawal thresholds to mechanical (von Frey) and thermal stimuli and joint edema were assessed before induction of inflammation and immediately before and after application of TENS.

Results

Reduced paw withdrawal threshold and thermal latency that occur 24 h after the induction of inflammation were significantly reversed by the administration of TENS in all groups when compared with sham treatment or with the condition before TENS treatment. No difference was observed in the edema measurement.

Conclusion

These results offer more options for practitioners to choose the area of the body most commodious for electrode placement, depending on the clinical condition of the patient, because the effect was similar at all sites. In addition, there was a loss of the effectiveness of TENS in reversing mechanical and thermal hyperalgesia on the fifth day, suggesting the development of the tolerance phenomenon.