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The use of patient-controlled transcutaneous electronic nerve stimulation (TENS) to decrease the discomfort of regional anaesthesia in dentistry: a randomized controlled clinical trial
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Complementary Therapies in Medicine
The identification of musculoskeletal abnormalities in headache patients has led to the incorporation of physical therapy (PT) into treatment programs for chronic headache. The current studies: (i) investigated the efficacy of PT as a treatment for migraine, and (ii) investigated the utility of PT as an adjunct treatment in patients who fail to improve with relaxation training/thermal biofeedback (RTB). PT alone is not effective in reducing headache, with only 14% of subjects reporting significant headache reduction (mean reduction of 15.6% in comparison with 41.3% in RTB). However, PT may have been a useful adjunct, with 47% of a group of 11 subjects who had failed to improve with RTB reporting improvement with the addition of PT. It is recommended that RTB remain the nonmedical treatment of choice for migraine, and that PT may be a useful adjunct for patients who fail to improve after such treatment.
Meechan JG, Gowans A J, Welbury RR. The use of patient-controlled transcutaneous electronic nerve stimulation (TENS) to decrease the discomfort of regional anaesthesia in dentistry: a randomized controlled clinical trial. Journal of Dentistry 1998; 26: 417-420. Objective: To compare the use of topical anaesthesia and transcutaneous electronic nerve stimulation (TENS) as means of reducing the discomfort of inferior dental block injections. Methods: One hundred adult dental patients received 2% lignocaine with 1:80 000 adrenaline for long buccal and inferior dental block anaesthesia. The long buccal injections were given first with no prior mucosal preparation. Patients received inferior dental blocks after one of the following mucosal preparations: (1) no pretreatment; (2) a 2 min application of 20% benzocaine topical anaesthetic; (3) application of patient-controlled TENS at the injection site. Patients scored injection discomfort after each administration on a 100 mm visual analogue scale. Results: The discomfort of the long buccal injection did not differ between the three groups of patients (F2,97 = 1.0). There were significant differences in the pain scores for the inferior dental block injections (F2,97 = 5.3; P < 0.01). Injection discomfort following TENS was less than that following no pretreatment (P < 0.01) and after topical anaesthetic application (P < 0.05). The use of topical anaesthesia did not produce a significant change in injection discomfort compared with no pretreatment. Conclusion: The use of TENS reduces injection discomfort during inferior dental block anaesthesia. Ross Petersen L, Johansen C, Olsen JH. Does psychosocial intervention in cancer patients affect survival and psychological well-being? Ugeskrift for Laeger 1998; 160: 5625-634. We have critically reviewed the scientific literature examining the effect of psychosocial interventions on survival and well-being among adult cancer
patients. Only studies using randomization and including a control-group not receiving psychosocial intervention were reviewed. Six studies examined the effect on prognosis. In four of these studies survival increased significantly in the intervention group as compared to the control group. All of these studies, however, have methodological flaws, leaving a possible prognostic effect to be clarified in larger, well-controlled future studies. The effect of psychosocial intervention on various psychosocial variables (such as anxiety and depression) was evaluated in 20 studies. Differences in patient populations, intervention strategies, and outcomes decrease the comparability of the results, and the majority of these studies suffer from methodological flaws as well. A positive effect on anxiety and depression immediately following the intervention is, however, reported in the majority of these studies. It is thus possible that the level of anxiety and depression may be decreased by integrating psychosocial intervention in the overall treatment of cancer.
Sellick SM, Zaza C. Critical review of 5 nonpharmacologic strategies for managing cancer pain. Cancer Prevention & Control 1998; 2: 7-14. Purpose: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. Methods: The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonphramacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. Results: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. Conclusion: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed. Bensoussan A, Talley N J, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syn-
Complementary Therapies in Medicine
The identification of musculoskeletal abnormalities in headache patients has led to the incorporation of physical therapy (PT) into treatment programs for chronic headache. The current studies: (i) investigated the efficacy of PT as a treatment for migraine, and (ii) investigated the utility of PT as an adjunct treatment in patients who fail to improve with relaxation training/thermal biofeedback (RTB). PT alone is not effective in reducing headache, with only 14% of subjects reporting significant headache reduction (mean reduction of 15.6% in comparison with 41.3% in RTB). However, PT may have been a useful adjunct, with 47% of a group of 11 subjects who had failed to improve with RTB reporting improvement with the addition of PT. It is recommended that RTB remain the nonmedical treatment of choice for migraine, and that PT may be a useful adjunct for patients who fail to improve after such treatment.
Meechan JG, Gowans A J, Welbury RR. The use of patient-controlled transcutaneous electronic nerve stimulation (TENS) to decrease the discomfort of regional anaesthesia in dentistry: a randomized controlled clinical trial. Journal of Dentistry 1998; 26: 417-420. Objective: To compare the use of topical anaesthesia and transcutaneous electronic nerve stimulation (TENS) as means of reducing the discomfort of inferior dental block injections. Methods: One hundred adult dental patients received 2% lignocaine with 1:80 000 adrenaline for long buccal and inferior dental block anaesthesia. The long buccal injections were given first with no prior mucosal preparation. Patients received inferior dental blocks after one of the following mucosal preparations: (1) no pretreatment; (2) a 2 min application of 20% benzocaine topical anaesthetic; (3) application of patient-controlled TENS at the injection site. Patients scored injection discomfort after each administration on a 100 mm visual analogue scale. Results: The discomfort of the long buccal injection did not differ between the three groups of patients (F2,97 = 1.0). There were significant differences in the pain scores for the inferior dental block injections (F2,97 = 5.3; P < 0.01). Injection discomfort following TENS was less than that following no pretreatment (P < 0.01) and after topical anaesthetic application (P < 0.05). The use of topical anaesthesia did not produce a significant change in injection discomfort compared with no pretreatment. Conclusion: The use of TENS reduces injection discomfort during inferior dental block anaesthesia. Ross Petersen L, Johansen C, Olsen JH. Does psychosocial intervention in cancer patients affect survival and psychological well-being? Ugeskrift for Laeger 1998; 160: 5625-634. We have critically reviewed the scientific literature examining the effect of psychosocial interventions on survival and well-being among adult cancer
patients. Only studies using randomization and including a control-group not receiving psychosocial intervention were reviewed. Six studies examined the effect on prognosis. In four of these studies survival increased significantly in the intervention group as compared to the control group. All of these studies, however, have methodological flaws, leaving a possible prognostic effect to be clarified in larger, well-controlled future studies. The effect of psychosocial intervention on various psychosocial variables (such as anxiety and depression) was evaluated in 20 studies. Differences in patient populations, intervention strategies, and outcomes decrease the comparability of the results, and the majority of these studies suffer from methodological flaws as well. A positive effect on anxiety and depression immediately following the intervention is, however, reported in the majority of these studies. It is thus possible that the level of anxiety and depression may be decreased by integrating psychosocial intervention in the overall treatment of cancer.
Sellick SM, Zaza C. Critical review of 5 nonpharmacologic strategies for managing cancer pain. Cancer Prevention & Control 1998; 2: 7-14. Purpose: Health care professionals at 2 Ontario cancer centres were surveyed to determine their familiarity with, perceptions of and interest in learning more about nonpharmacologic strategies for the management of cancer pain. Evidence-based education sessions were subsequently developed for the 5 strategies in which participants were most interested. This article presents the results of critical literature reviews concerning the effectiveness of the 5 strategies: acupuncture, massage therapy, hypnosis, therapeutic touch and biofeedback. Methods: The databases MEDLINE (1966 to June 1997), CINAHL (1982 to June 1997) and PsychoINFO Lit (1980 to June 1997) were searched systematically for randomized controlled trials (RCTs) of the 5 nonphramacologic strategies. The authors' personal files and reference lists of relevant papers and main texts were also searched. The quality of the trials was reviewed according to established criteria. Results: The search yielded 1 RCT of acupuncture, 1 of massage therapy and 6 of hypnosis. The studies of hypnosis suggested that there is much support for its use in the management of cancer pain. The evidence was either lacking or less clear for the other therapies examined. Conclusion: Because patients use a wide variety of nonpharmacologic strategies regardless of their effectiveness, clinicians need to be familiar with available research and able to discuss those strategies for which the evidence is strong, weak or nonexistent. More research on the effectiveness of nonpharmacologic strategies for pain management is needed. Bensoussan A, Talley N J, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syn-