Effects of transcutaneous electrical nerve stimulation TENS and interferential currents IFC in patients with nonspecific chronic low back pain: randomized clinical trial. Address for correspondence. The aim of this study was to compare the effects of TENS and interferential current among patients with nonspecific chronic low back pain. The patients designated for electrotherapy received ten minute sessions, while the control group remained untreated. All patients and controls were evaluated before and after treatment using a visual analog scale and the McGill Pain and Roland Morris questionnaires, and regarding their use of additional medications.
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Effects of transcutaneous electrical nerve stimulation TENS and interferential currents IFC in patients with nonspecific chronic low back pain: randomized clinical trial.
Address for correspondence. The aim of this study was to compare the effects of TENS and interferential current among patients with nonspecific chronic low back pain. The patients designated for electrotherapy received ten minute sessions, while the control group remained untreated.
All patients and controls were evaluated before and after treatment using a visual analog scale and the McGill Pain and Roland Morris questionnaires, and regarding their use of additional medications. In the Roland Morris questionnaire, group 1 had a mean reduction of 6. Key words: Physical therapy specialty. Electric stimulation therapy. Back pain. Palavras-chave: Fisioterapia especialidade. Dor nas costas. Coluna vertebral.
Complaints of low back pain with or without irradiation are the second most common reason why workers seek healthcare assistance. If the pain is under control, patients will be more capable of carrying out the program of activities. This provides justification for using electrotherapy. Electrotherapy, which is a noninvasive, non-pharmacological method involving transcutaneous electrical stimulation, is an additional alternative for low back pain management.
The electrotherapy methods most used in clinical practice are transcutaneous electrical nerve stimulation TENS and interferential currents IFC. Many researchers have investigated the effectiveness of TENS for treating chronic low back pain. Some studies on IFC application have been performed, to investigate its effects on induced pain 12,13 and in relation to different diseases.
No meaningful differences between them were found. However, we were unable to find any studies comparing these two techniques for treating chronic low back pain. The purpose of the present study was to compare the analgesic effects of TENS and IFC among nonspecific chronic low back pain patients.
To be included in this study, they had to be more than 18 years old and had to have been seeking treatment after assessment by a doctor for chronic low back pain, defined as pain localized below the scapulae and above the cleft of the buttocks, with or without leg pain, which they had had for more than three months.
Their pain had to be nonspecific, meaning that no specific cause was detectable, such as infection, neoplasms, metastasis, osteoporosis, rheumatoid arthritis, fractures or inflammatory processes. The following patients were excluded from the study: individuals who had had low back pain for less than three months; individuals who were receiving treatment for their pain with another method at the same time, except for medicines; pregnant women; patients who had undergone vertebral column surgery less than three months before the time of this study ; individuals with contraindications against electrotherapy, such as skin lesions, abnormal sensitivity, infectious and blood diseases, heart pacemakers or inability to answer questionnaires; patients with fibromyalgia; individuals with psychiatric problems; and individuals who refused to participate or were unwilling to follow a protocol lasting for two weeks.
After selection through consultation with a doctor, the patients provided their written consent and were given an opportunity to ask any questions regarding the procedure.
This examiner did not follow the treatment and did not know which group the patients had been included in. After each treatment session, however, the pain intensity was also evaluated using VAS among the patients that received TENS and interferential current. The randomized design was balanced in groups of A set of sealed, sequentially numbered opaque envelopes was used for study group assignment.
Thus, the study was single-blinded, i. The treatment was applied over a two-week period, in ten sessions. For both intervention groups, the stimulation was administered for 30 minutes, using a strong, but comfortable intensity that was adjusted according to each patient's sensitivity.
Four self-adhesive Valutrode electrodes with dimensions of 5 x 5 cm were placed over the T 12 and S 1 lines. The TENS equipment was calibrated at a frequency of 20 Hz and a pulse width of ms, with two channels. The frequency of 20 Hz was chosen in accordance with suggestions from previous study results. All the patients received guidance folders about vertebral column care. This was the only intervention administered to the patients who were chosen for the control group.
These patients remained on a waiting list for 15 days, until beginning conventional physiotherapy treatment at the same clinic. The VAS was applied every day, before and after the session. In addition, the patients filled out a questionnaire in which, aided by a physiotherapist, they stated for how long their pain relief after the session had lasted and whether they had used any painkillers or anti-inflammatory drugs prescribed by the doctor, and what dosages they used.
After completing the 10 sessions, the patients were reassessed by an independent evaluator who used the same instruments. In the event of dropout, i. Statistical analysis. All data were analyzed using Statistica version 7 and SAS version 9.
The characteristics of the patients who finished the treatment were compared with those of the lost patients, using one-way Anova and the Kruskal-Wallis test. Anova for repeated measurements was used to determine the effects among the treatment groups by comparing their mean values. The decreases in VAS in groups 1 and 2 following each session and the PPI, NWC and PRI indexes before and after the treatment in groups 1, 2 and 3 were investigated using Anova for repeated measurements, and the means for the groups were also compared using Duncan's test.
For the pain intensity variable alone, examined using VAS, the statistical analysis was performed with all the patients selected at random according to intention to treat. For this, all the patients included in the study were taken into consideration. For this purpose, the reasons for giving up the treatment were investigated.
The patients were classified as with pain or without pain, independent of their pain intensity. The signal hypothesis test and Wilcoxon test were then applied to investigate whether there were any changes in pain levels in each patient group. The consumption of medications was analyzed by means of simple frequency tables.
The McNemar test was applied to investigate whether there was any association between the use of medicine and the treatment. The use of non-steroidal anti-inflammatory drugs and analgesic drugs was analyzed by means of simple frequency tables, with double data entry.
Sample size calculation. To achieve this, the sample size was set at 47 patients, supposing a total of participants. The total number of low back pain patients selected was Out of these, were excluded for a variety of reasons, and thus patients were included in the study and evaluated.
Thirteen patients 8. Thus, patients completed the treatment protocol Figure 1. Table 1 shows the demographic features of the population included in this study according to group allocation. Pain intensity VAS. Thus, it could be seen that although the pain intensity was heterogeneous at the beginning of the study, it became homogeneous between the groups from the second session onwards.
The mean pain decreased over the course of the treatment in both groups. Group 2 presented a more significant reduction in the seventh session Figures 2 and 3. Assessment of mean pain intensity VAS before and after the treatment showed that the means decreased in all three groups. Although there was no statistically significant difference between groups 1 and 2 using Duncan's test, the IFC patents presented greater pain reduction. The control group presented statistically significant differences with the other two groups.
The intention-to-treat analysis included all the patients with VAS pain evaluations, and the worst results were considered to be losses. The results from this evaluation were statistically significant in relation to decreased pain intensity in groups 1 and 2, but not in group 3 Table 3. After the treatment, the means for groups 1 and 2 were different from the mean for group 3 but were the same as each other.
The decrease in PPI was greater in group 1 Duration of analgesia. The duration of the analgesia caused by TENS and IFC in each session was measured in hours, at hour intervals after the patient finished the session Figure 5. There was an increasing trend in the mean duration of analgesia over the course of the sessions, up to a climax in the tenth session for the TENS group and the ninth for the IFC. Disability was analyzed using the RMDQ, and showed improvements in all the groups. The statistical analysis showed that the proportions of the patients who stopped using the medications were similar between groups 1 and 2, but different from group 3.
There were no differences in the numbers of patients in group 3 who were using between one and ten analgesics and those using NSAIDs.
We emphasize that in all the groups, most of the patients were not using any drugs. Group 2 presented the largest number of patients Group 3 was bigger than the others According to the results presented, TENS and IFC produced significant effects in relation to pain intensity reduction, disability improvement and reduction in medication consumption. These results did not occur in the control group. Although 13 patients 8. It is difficult to achieve complete masking of patients in physiotherapy investigations, since there are differences between visual sensory and alternative treatments.
Although these previous results were not similar to those of the present study, it was not possible to make direct comparisons between the previous and present results because of the different methodologies used in the research. There was no statistically significant difference between the groups.
Marchand et al. However, the methodology of their study can be criticized because it included patients with different diseases, such as ankylosing spondylitis and rheumatoid arthritis, thus differing from the present study, which did not use placebo for comparisons of possible results.
In a randomized clinical trial, Deyo et al. Over the same period, the groups that performed workouts, whether or not in association with TENS, showed meaningful improvements in their painful state, or in function or pain frequency.
Their findings are not in agreement with the present study, which detected significant differences between the treatment groups and the control group. Cheing and Hui-Chan 10 described the effects of a minute TENS session on chronic clinical pain, acute experimental pain and chronic low back pain.
Neither TENS nor placebo produced significant changes in experimentally induced pain. Methodological differences, especially relating to the duration of the treatment, make it difficult to correlate their data with the information from the present study.
In a recent systematic review, Khadilkar et al. The methodology of the present study sought to use the parameters suggested by the systematic review of Khadilkar et al.
2011, Number 2
Accessed in Mar Sluka KA, Walsh D. Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. J Pain. The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee.
artigo interferencial e tens
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