Efeitos da estimulação elétrica nervosa transcutânea (TENS) e da corrente interferencial (CI) em pacientes com lombalgia crônica não específica
ensaio clínico randomizado
Palavras-chave:
Fisioterapia (especialidade), Reabilitação, Terapia por estimulação elétrica, Dor nas costas, Coluna vertebralResumo
CONTEXTO E OBJETIVO: Estimulação elétrica nervosa transcutânea (TENS) e corrente interferencial são os métodos de eletroterapia mais utilizados, embora haja poucas evidências científicas que suportem seu uso. O objetivo deste estudo foi comparar os efeitos da TENS e da corrente interferencial em pacientes com lombalgia crônica não específica. TIPO DE ESTUDO E LOCAL: Ensaio clínico randomizado, simples-cego, no Departamento de Fisioterapia do Centro Universitário de Maringá. MÉTODOS: Cento e cinquenta pacientes foram randomicamente divididos em três grupos: TENS (grupo 1), corrente interferencial (grupo 2) e controle (grupo 3). Os pacientes designados à eletroterapia receberam 10 sessões de 30 minutos, enquanto o grupo controle permaneceu sem tratamento. Todos os pacientes e os controles foram avaliados antes e depois do tratamento usando a escala visual analógica, os questionários McGill de dor e Roland Morris, e quanto ao uso de medicamentos. RESULTADOS: Houve redução média na escala visual analógica de 39,18 mm com TENS, de 44,86 mm com a corrente interferencial e 8.53 mm no grupo controle. No questionário Roland Morris, o grupo 1 teve redução média de 6,59, o grupo 2 de 7,20 e o grupo 3 de 0,70 pontos. 84% dos pacientes do primeiro grupo, 75% no segundo e 34% no terceiro grupo cessaram a medicação depois do tratamento. Não foi encontrada diferença estatisticamente quando comparados os grupos de TENS e corrente interferencial (P > 0,05), apenas quando comparados estes grupos com o controle (P < 0,0001). CONCLUSÕES: Não há diferença entre TENS e corrente interferencial no tratamento de pacientes com lombalgia crônica. REGISTRO DE ENSAIO CLÍNICO: NCT01017913.
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Referências
van Tulder M, Koes B, Bombardier C. Low back pain. Best Pract Res Clin Rheumatol. 2002;16(5):761-75.
DeRosa CP, Porterfield JA. A physical therapy model for the treatment of low back pain. Phys Ther. 1992;72(4):261-9; discussion 270-2.
Jackson DA. How is low back pain managed? Retrospective study of the first 200 patients with low back pain referred to a newly established community-based physiotherapy department. Physiotherapy. 2001;87(11):573-81. Available from: http://www. physiotherapyjournal.com/article/S0031-9406(05)61124-8/abstract. Accessed in 2011 (Mar 16).
Sluka KA, Walsh D. Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. J Pain. 2003;4(3):109- 21.
Jarit GJ, Mohr KJ, Waller R, Glousman RE. The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee. Clin J Sport Med. 2003;13(1):16-20.
Li LC, Bombardier C. Physical therapy management of low back pain: an exploratory survey of therapist approaches. Phys Ther. 2001;81(4):1018-28.
Melzack R, Vetere P, Finch L. Transcutaneous electrical nerve stimulation for low back pain. A comparison of TENS and massage for pain and range of motion. Phys Ther. 1983;63(4):489-93.
Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. N Engl J Med. 1990;322(23):1627-34.
Marchand S, Charest J, Li J, Chenard JR, Lavignolle B, Laurencelle L. Is TENS purely a placebo effect? A controlled study on chronic low back pain. Pain. 1993;54(1):99-106.
Cheing GL, Hui-Chuan CW. Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain. Arch Phys Med Rehabil. 1999;80(3):305-12.
Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low- back pain. Cochrane Database Syst Rev. 2008;(4):CD003008.
Johnson MI, Tabasam G. A single-blind placebo-controlled investigation into the analgesic effects of interferential currents on experimentally induced ischaemic pain in healthy subjects. Clin Physiol Funct Imaging. 2002;22(3):187-96.
Johnson MI, Tabasam G. An investigation into the analgesic effects of interferential currents and transcutaneous electrical nerve stimulation on experimentally induced ischemic pain in otherwise pain-free volunteers. Phys Ther. 2003;83(3):208-23.
Taylor K, Newton RA, Personius WJ, Bush FM. Effects of interferential current stimulation for treatment of subjects with recurrent jaw pain. Phys Ther. 1987;67(3):346-50.
Jarit GJ, Mohr KJ, Waller R, Glousman RE. The effects of home interferential therapy on post-operative pain, edema, and range of motion of the knee. Clin J Sport Med. 2003;13(1):16-20.
Raimundo AKS, Brandão DL, Lucena KG. Estudo comparativo do efeito analgésico entre frequências da corrente interferencial na fibromialgia [Comparative study of the analgesic effect between frequencies of interferential current in the fibromyalgia] Fisioter Mov. 2004;17(4):65-72.
González Roig JL, Portuondo Peña S, Molina García JR. Las corrientes interferenciales en el tratamiento del dolor lumbosacro cronico [Interferential currents in the treatment of chronic low back pain]. Rev Cuba Ortop Traumatol. 1992;6(1):54-60.
Werners R, Pynsent PB, Bulstrode CJ. Randomized trial comparing interferential therapy with motorized lumbar traction and massage in the management of low back pain in a primary care setting. Spine (Phila Pa 1976). 1999;24(15):1579-84.
Hurley DA, Minder PM, McDonough SM, et al. Interferential therapy electrode placement technique in acute low back pain: a preliminary investigation. Arch Phys Med Rehabil. 2001;82(4):485-93.
Hurley DA, McDonough SM, Dempster M, Moore AP, Baxter GD. A randomized clinical trial of manipulative therapy and interferential therapy for acute low back pain. Spine (Phila Pa 1976). 2004;29(20):2207-16.
Hurley DA, McDonough SM, Baxter GD, Dempster M, Moore AP. A descriptive study of the usage of spinal manipulative therapy techniques within a randomized clinical trial in acute low back pain. Man Ther. 2005;10(1):61-7.
Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56.
Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987;30(2):191-7.
Pimenta CAM, Teixeira MJ. Questionário de dor McGill: proposta de adaptação para a língua [McGill Pain Questionnaire: adaptation into the portuguese language]. Rev Bras Anestesiol. 1997;47(2):177-86.
Castro CES. A formulação lingüística da dor: versão brasileira do Questionário McGill de dor [dissertation]. São Carlos: Universidade Federal de São Carlos; 1999.
Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation, adaptation and validation of the Roland-Morris questionnaire--Brazil Roland- Morris. Braz J Med Biol Res. 2001;34(2):203-10.
Johnson MI, Ashton CH, Bousfield DR, Thompson JW. Analgesic effects of different frequencies of transcutaneous electrical nerve stimulation on cold-induced pain in normal subjects. Pain. 1989;39(2):231-6.
Deyo RA, Walsh NE, Schoenfeld LS, Ramamurthy S. Can trials of physical treatments be blinded? The example of transcutaneous electrical nerve stimulation for chronic pain. Am J Phys Med Rehabil. 1990;69(1):6-10.
Johnson MI, Ashton CH, Thompson JW. The consistency of pulse frequencies and pulse patterns of transcutaneous electrical nerve stimulation (TENS) used by chronic pain patients. Pain. 1991;44(3):231-4.
Cramp FL, Noble G, Lowe AS, Walsh DM, Willer JC. A controlled study on the effects of transcutaneous electrical nerve stimulation and interferential therapy upon the RIII nociceptive and H-reflexes in humans. Arch Phys Med Rehabil. 2000;81(3):324-33.
Wang JQ, Mao L, Han JS. Comparison of the antinociceptive effects induced by electroacupuncture and transcutaneous electrical nerve stimulation in the rat. Int J Neurosci. 1992;65(1-4):117-29.
Köke AJ, Schouten JS, Lamerichs-Geelen MJ, et al. Pain reducing of three types of transcutaneous electrical nerve stimulation in patients with chronic pain: a randomized crossover trial. Pain. 2004;108(1- 2):36-42.
Johnson MI, Tabasam G. A double blind placebo controlled investigation into the analgesic effects of interferential currents (IFC) and transcutaneous electrical nerve stimulation (TENS) on cold- induced pain in healthy subjects. Physiotherapy Theory and Practice. 1999;15(4):217-33. Available from: http://informahealthcare.com/doi/abs/10.1080/095939899307630. Accessed in 2011 (Mar 16).
Johnson MI, Tabasam G. An investigation into the analgesic effects of different frequencies of the amplitude-modulated wave of interferential current therapy on cold-induced pain in normal subjects. Arch Phys Med Rehabil. 2003;84(9): 1387-94.
Cheing GL, Hui-Chan CW. Analgesic effects of transcutaneous electrical nerve stimulation and interferential currents on heat pain in healthy subjects. J Rehabil Med. 2003;35(1):15-9.
Romani ED, Spironello A, Almeida M, Souza MZ. Efeito da terapia interferencial em pacientes com lombalgia aguda. Anais do IV Simpósio Internacional de Fisioterapia. Rev Fisioter Univ São Paulo. 1999;6(Special Suppl):36-71. [abstract].
Solano LR, Sanhueza CA, Carter BM, Bianchi LD, Riedemann GP. Electroanalgesia en el síndrome de dolor lumbar agudo: efectividad comparativa de TIF versus TENS: estudio preliminary [Electro-analgesia in the low back pain syndrome: comparative effectiveness of TIF versus TENS: preliminary study]. Rev Chil Reumatol. 2006;22(4):142-6.
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