Electroanalgesia in chronic low back pain

Low back pain or low back pain is a set of painful manifestations, affecting 90% of the population, including the elderly and young people. It has numerous causes, such as joint degeneration, biomechanical and functional changes, incorrect posture, among others. Thus, there is limitation in ROM, pain, burning sensation and functional incapacity. Electrotherapy is the use of electrical currents for different therapeutic purposes. It is used to control pain, reduce edema and muscle spasm. To identify the effects of electroanalgesia on pain in patients with low back pain chronic. Anon-systematic review of the literature was performed, where randomized clinical trials published between 2006 and 2020 were selected, according to the highest score in the scorePEDro. The search involved the databases PEDro e PubMed, through the following terms: electroanalgesia, chronic, back pain, backache, TENS, electrotherap, placebo, massage. Six studies with a PEDro score between 7 and 10 were selected. In all studies, electroanalgesia was compared with massage or placebo. In five studies, when TENS was compared with massage, there was an immediate reduction in pain, improvement in disability and a reduction in medication consumption. In one study, after ten sessions there was no difference between TENS and interferential current. Another study showed that laser was more effective than TENS in reducing pain. There is no difference between TENS and interferential current. Electroanalgesia appears, in the short term, to reduce pain, medication consumption, as well as improve disability. Laser is more effective than TENS in reducing pain.

Sciatica: Treatment with a Blend of Maitland Mobilization, McKenzie Exercises along with NMES - A Case Study

Sciatica is referred to radiculopathy involving any of the lower extremity, caused by either inflammation or compression of the nerve roots L1-S1. It can be diagnosed majorly through an appropriate history taking and physical examinations to not be misdiagnosed with other chronic low back pain conditions. A conservative management is preferred when in an acute stage of 6-8 weeks after which a surgical approached is advised. Although various studies has shown evidences that a prolonged conservative care is most fitting than a short term surgical approach (discectomy). The prevalence of sciatic symptoms ranging from 1.6% to 43%, maximum noted in the working population, has drawn attention for the need of an effective and early conservative care to downsize the symptoms causing discomfort and pain. Thus, the aim of the case report was to present with an early and effective conservative care with a blend of Maitland Mobilization, McKenzie exercises along with Neuro-Muscular Electrical Stimulation (Interferential Current) to minimize the discomfort thus easing and bolstering the individual in activities of daily living followed by an uncomplicated returning back to recreational activities. The patient was managed with a blend of Maitland Mobilization, McKenzie exercises and Interferential current for 7 days consecutively along with an individually tailored Home exercise program according the patient tolerance. Outcomes measures namely numerical pain rating scale, lower extremity functional scale and Roland Morris Disability Questionnaire were evaluated before and after the 7 day intervention period to assess prognosis in pain and pain related disability. Thus the changes in pre and post intervention results stated positive outcomes in reducing pain and improving the functional activity and participation in social and recreational ventures. Keywords: Sciatica, Maitland Mobilization, Mckenzie exercise, Interferential Therapy, radicular pain.

INTERFERENTIAL CURRENT, ULTRAHIGH-FREQUENCY CURRENT, AND EXERCISES FOR RECURRENT KNEE PAIN DUE TO OSTEOARTHRITIS

Introduction:- There are no studies in the literature on the combined effect of interference current, ultrahigh-frequency current, and exercise in recurrent knee pain due to osteoarthritis. There is no consensus on the optimal frequency, duration, and intensity of exercise. Aim:- To study the effect of interferential current, ultrahigh-frequency current, and exercises in recurrent knee pain due to osteoarthritis and to discover the optimal frequency, intensity, and duration of exercises. Material and Methods:- Twelve outpatients (age 63.43±6.24 years) with recurrent knee pain due to osteoarthritis (average pain duration 6.71±5.21 years and last recurrence 3.92±1.56 before study enrolment) were followed-up for one month. They were treated for the first two weeks with interferential current, ultrahigh-frequency current, and exercises. All outpatients were instructed to perform the exercises as often as possible, as long as possible, and as intense as possible at home for one month. The pain was measured by a visual analogue scale daily for the two-week course and after one month. In the beginning, in the middle, and at the end of the month were recorded the mobility in the knee joints by goniometry, the strength of the periarticular muscles by manual muscle testing, WOMAC parameters, frequency, intensity, and duration of the exercises. Results:- During the two-week course, the pain was decreasing every following day (P>0.05). Over the weekend the pain increased (P<0.05). After two weeks and after one month the pain (P<0.05), mobility (P>0.05), muscle strength (P>0.05), and WOMAC parameters (P>0.05) significantly improved. There was a significant correlation and regression between pain and exercise frequency (P<0.05). With an exercise frequency greater than five times daily, the pain regressed to zero (P<0.05). There was no correlation between pain and exercise intensity (P>0.05) and between pain and exercise duration (P>0.05). Discussion:- The improvement of the pain during the week and its worsening during the weekend showed that interferential current and ultrahigh-frequency current had a short-term analgesic effect. The improvement of all parameters after one month showed that exercises had a long-term effect. The presence of a correlation and regression between pain and exercise frequency, combined with a lack of correlation between pain and exercise intensity or duration, indicated that frequent, short, and low-intensity exercises were optimal. Conclusion:- The combination between interferential current, ultrahigh-frequency current, and exercise is effective in recurrent knee pain due to osteoarthritis. Short and low-intensity exercises with a frequency of more than five times a day are optimal.

Interferential current and photobiomodulation in knee osteoarthritis: A randomized, placebo-controlled, double-blind clinical trial

Objectives: To evaluate the effects of interferential current and photobiomodulation in patients with knee osteoarthritis. Design: A randomized, placebo-controlled, double-blind clinical trial. Setting: Physiotherapy Clinic of City University of São Paulo. Subjects: A total of 184 patients with knee osteoarthritis were recruited and, of these, 168 were included and randomized into four groups with 42 each: interferential current, photobiomodulation, interferential current plus photobiomodulation or placebo groups. One hundred and sixty-four patients completed the study. Intervention: Patients received 12 sessions (three times a week) of treatment: 30 minutes of interferential current (active or placebo) followed by photobiomodulation (active or placebo). Main measures: Primary outcome: pain intensity at rest and during movement (numeric rating scale) after 12 sessions. Secondary outcomes: functional capacity (Timed Up & Go and Sit and Lift tests and Lequesne and WOMAC questionnaires), pressure pain threshold, conditioned pain modulation, and muscle strength production (isokinetic evaluation). Patients were assessed at baseline, after 12 sessions, and three and six months after the end of the treatment. Results: Interferential current plus photobiomodulation reduced pain intensity at rest and during movement compared to placebo and interferential current at all time points ( P < 0.05). Photobiomodulation reduced pain intensity at rest compared to placebo at all time points ( P < 0.05) and compared to interferential current at six months follow-up ( P < 0.05). Photobiomodulation reduced pain intensity during movement compared to placebo at six months follow-up ( P < 0.05). Conclusion: Interferential current plus photobiomodulation or isolated photobiomodulation improve pain intensity in knee osteoarthritis.