ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Therapeutic Use Of Transcutaneous Electrical Nerve Stimulators For Temporomandibular Joint Disorder Pain Relief
Clinical Question In a 40 year old female with chronic TMD, does TENS (Transcutaneous Electrical Nerve Stimulators) provide better symptom relief compared against a placebo?
Clinical Bottom Line Currently there is not enough evidence to decide conclusively as to whether or not TENS can provide pain relief for TMD patients. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17383095Johnson/2007A review of 134 total research papers; the inclusion criteria was met by 29 articles with 38 studies. Comprised of 32 TENS (Transcutaneous Electrical Nerve Stimulation) studies, and 6 PENS (Percutaneous Electrical Nerve Stimulation) studies. Total participants in the study were 1227, of which 892 were ENS (combined TENS and PENS studies)Meta Analysis
Key resultsFor all studies combined, “ENS reduced pain significantly more than placebo using a random effects model (p<0.0005)." “On average, the pain relief provided by ENS was nearly three times the pain relief provided by placebo.”
#2) 12366541Alvarez-Arenal/2002“24 individuals with an average age of 36•5 years (15 males and nine females). 13 were clenchers and 11 grinders. 19 patients presented with TMD.”Randomized Controlled Trial
Key resultsFor patients with TMD symptoms, the occlusal splint and TENS did not significantly provide pain relief, in association with muscle or joint tenderness. P-values were Not Significant.
#3) 18646088Nnoaham/2008“25 RCTs involving 1281 participants with various chronic pain conditions of more than 3 months duration were evaluated.”Systematic Review
Key resultsThere have not been any significant findings since the previous version of this systematic review. There have not been enough stringent studies with a comparison using a gold standard. Therefore, at this time it would be difficult to make any conclusions as to the efficacy of TENS in TMD related illness.
Evidence Search Search temporomandibular joint disorder pain management Limits: Humans, Randomized Controlled Trial, EnglishSearch temporomandibular joint disorder pain management Limits: Humans, Meta-Analysis, EnglishSearch temporomandibular joint disorder alternative treatment Limits: Humans, Meta-Analysis, EnglishSearch temporomandibular joint disorder electrical nerve stimulation Limits: Humans, Meta-Analysis, English Search temporomandibular joint disorder transcutaneous electrical nerve stimulation Limits: Humans, Meta-Analysis, English
Comments on
The Evidence
The 1st article (Johnson 2007) provided a meta-analysis of 29 papers with 38 studies that met the inclusion criteria in relation to a broad categorical summation of patients with various chronic pain conditions. For all the studies combined, TENS reduced pain significantly more than the placebo using a random-effects model (p<0.0005). The 2nd article (Alvarez-Arenal 2002) was a crossed-design experimental study involving simple blind-paired data and random assignment to treatment, with the aim of evaluating action of an occlusal splint with TENS upon the manifestation of TMD in patients with bruxism. The results of this study, suggests that TENS is ineffective in the treatment of TMD related pain.The 3rd article (Nnoaham 2008) is a systematic review of TENS in the treatment of chronic pain. The review provided an update to a previous review of relevant literature, which was inconclusive as to the efficacy of TENS. The current review still fails to provide any conclusive support to the role that TENS may play in the treatment of pain.
Applicability Based on the hierarchy of evidence accumulated by the 3 articles with Meta Analysis being the highest, it would appear that TENS does provide a reduction in symptoms for patients with different categories of chronic pain. It is also useful to view the 1st article in light of the fact that the remaining 2 articles, which focused on the category of TMD pain, produced less conclusive results as to the effectiveness of TENS in the treatment of symptoms.
Specialty/Discipline (General Dentistry) (Oral Surgery) (Orthodontics)
Keywords Temporomandibular Disorders, TMD, Transcutaneous Electrical Nerve Stimulators, TENS, Chronic Pain
ID# 809
Date of submission: 04/05/2011spacer
E-mail ChoiJH@livemail.uthscsa.edu
Author Jin H. Choi
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
post a comment
by Hesham Alsaigh and Salim Aqil (San Antonio, TX) on 10/16/2014
We conducted a PubMed search on this topic October 2014 and found a more recent publication: PubMed ID: 24364193. This randomized controlled pilot study further supports the conclusion of this CAT.
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