Effect of Transcutaneous Electrical Nerve Stimulation for Controlling Pain Associated With Orthodontic Tooth Movement [Abstract]
Roth, Peter M., & Thrash,
William J. American Journal of Orthodontics, 90(2):132-138, 1986.
Forty-five adult subjects, 27
men and 18 women, between 22 and 41 years old (mean of 28 years) were randomly
assigned to an AlphaStim (TENS) group, a placebo group, and a control group
following the signing of an institutionally approved consent form at Baylor
College of Dentistry in Dallas, Texas. They were further subdivided into 18
seconds intraoral stimulation of 50 µA at 0.5 Hz, and 20 minutes of extraoral
stimulation of 500 µA at 0.5 Hz, and one, two and three day treatment duration
groups. In each subject Unitek S-1 elastic orthodontic separators were placed
mesial and distal to the upper first molars, bilaterally. Subjects were asked
to rate their discomfort every 12 hours for four days with a 10 cm visual
analogue scale (VAS) ranging from no pain to severe pain.
In the control group postseparation
tooth pain began between 0 and 12 hours, and lasted between 60 and 72 hours,
confirming previous published reports. There was a significant interaction
between treatment modality and measurement period. Those subjects receiving
Alpha-Stim treatment reported significantly (P<.001) lower VAS scores than
those receiving placebo at the 24, 36, and 48 hour assessment periods. The
total Alpha-Stim group VAS means dropped from 14.6 at 12 hours to 6.72 at 60
hours, while the placebo means changed from 13.33 to 12.89, and the control
group from 17.88 to 18.00. The effects of treatment location and applications
were not significant, there was no significant effect of treatment schedule on
reported pain levels as a single
application of Alpha-Stim was shown to be effective in reducing pain for more
than 48 hours and was as effective as two or three treatments. Nor was
there any significant difference between the placebo and control groups at any
time.
The authors noted that the
clinical application of their findings is significant. They describe possible
mechanisms of action, many potential benefits to dental patients, and suggest
that perhaps a reduction in the pain experienced during orthodontics would lead
to better patient compliance.
The graph shows that the one,
20 minute Alpha-Stim treatment reduced pain to the level that would be achieved
in all three groups at the end of the four day rating period when all mouths
were essentially healed. Though the 24 hour period ratings seemed to indicate a
placebo effect from the sham treated patients when compared with the placebo
controls, their was no significant difference found on testing of the means. In
fact, there were no statistically significant differences in the sham treated
and placebo control patients at any rating period, showing that while the
actual treatment was significantly effective in eliminating peridontal pain in
these patients, there was no placebo effect from the treatment condition.
Controlling Pain of Orthodontic Tooth Movement 493.98 Kb
|