Efficacy of acupuncture and electroacupuncture in patients with nonspecific low back pain: study protocol for a randomized controlled trial

Abstract\ud \ud Background\ud Previous studies have shown that acupuncture and electroacupuncture (EA) are effective in the treatment of patients with low back pain. However, there is little evidence to support the use of one intervention over the other. The aim of this study is to compare the effect of acupuncture and electroacupuncture in the treatment of pain and disability in patients with chronic nonspecific low back pain.\ud \ud \ud Methods/design\ud The study design is a randomized controlled trial. Patients with nonspecific chronic low back pain of more than three months duration are recruited at Rehabilitation Center of Taboao da Serra - SP (Brazil). After examination, sixty-six patients will be randomized into one of two groups: acupuncture group (AG) (n = 33) and electroacupuncture group (EG) (n = 33). Interventions will last one hour, and will happen twice a week for 6 weeks. The primary clinical outcomes will be pain intensity as measured and functional disability. Secondary outcomes: quality of pain, quality of life. perception of the overall effect, depressive state, flexibility and kinesiophobia. All the outcomes will be assessed will be assessed at baseline, at treatment end, and three months after treatment end. Significance level will be determined at the 5 % level. Results of this trial will help clarify the value of acupuncture and electroacupuncture as a treatment for chronic low back pain and if they are different.\ud \ud \ud Discussion\ud Results of this trial will help clarify the value of acupuncture needling and electroacupuncture stimulation of specific points on the body as a treatment for chronic low back pain.\ud \ud \ud Trial Registration\ud Clinicaltrials.gov: \ud NCT02039037\ud \ud . Register October 30, 2013.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-(CAPES

Effect of three physical therapy interventions relative to dental treatment in individuals with bruxism: a randomized clinical trial

Objetivos: Comparar o efeito de três intervenções de fisioterapia com tratamento odontológico na dor e sintomas, abertura mandibular, ansiedade, estresse, depressão, qualidade de saúde bucal e sono em indivíduos com bruxismo. Métodos: Noventa e seis indivíduos com dor e bruxismo do sono e vigília entre 18 e 60 anos de idade foram randomizados em quatro grupos: Grupo 1 (n=24) massoterapia e exercícios de alongamento muscular; Grupo 2 (n=24) terapia de relaxamento e imaginação; Grupo 3 (n=24) massoterapia, exercícios, relaxamento e imaginação e Grupo 4 (n=24) tratamento odontológico pela restauração direta. As variáveis primárias foram dor e sintomas, sendo a intensidade avaliada pela escala visual analógica e limiar de dor com dolorímetro; e abertura mandibular com paquímetro digital. As variáveis secundárias foram ansiedade avaliada com Inventário de Ansiedade Traço-Estado; estresse com Escala de Estresse Percebido; depressão com Inventário de Depressão de Beck; qualidade de saúde bucal com Perfil de Impacto de Saúde Bucal e sono com Índice de Qualidade de Sono de Pittsburgh. Todos os participantes foram avaliados antes, após seis semanas e dois meses das intervenções por avaliador cego. As intervenções de fisioterapia foram individualizadas por 40 minutos, duas vezes por semana, por seis semanas; e o tratamento odontológico incluiu duas sessões individuais, com intervalo de uma semana e duração de aproximadamente duas horas. O nível de significância estabelecido foi alfa=5%. Resultados: Após seis semanas, houve melhora com diferença significativa entre os Grupos 1, 2 e 3 e o Grupo 4 na dor muscular do masseter [Média da Diferença=2,3 / 2,7 / 5,5 (IC95%=0,2 a 4,4 / 0,9 a 4,4 / 3,8 a 7,2)], temporal anterior [Média da Diferença=2,6 / 2,1 / 5 (IC95%=0,5 a 4,7 / 0,1 a 4,1 / 3,2 a 6,7)], esternocleidomastóideo [Média da Diferença=3,3 / 4,2 / 6,1 (IC95%=1,6 a 4,9 / 2,6 a 5,8 / 4,6 a 7,5)] e trapézio superior [Média da Diferença=3,8 / 4,1 / 6,6 (IC95% = 2,1 a 5,5 / 2,3 a 5,5 / 5,4 a 7,7)]. Melhora similar foi encontrada nos sintomas de cefaleia, apertamento dentário e dificuldade de dormir, bem como no estado de ansiedade, estresse, depressão e qualidade de sono (p 0,05), respectivamente. Conclusão: Os dados sugerem que as três intervenções de fisioterapia comparadas a tratamento odontológico reduzem a dor e sintomas e indicam melhora da ansiedade, estresse, depressão e qualidade de sono. Os resultados apontam que as intervenções de fisioterapia: isolada (terapia de relaxamento e imaginação) e combinada (massoterapia, exercícios, relaxamento e imaginação) melhoram a qualidade de saúde bucal; e somente a combinada aumenta o limiar de dor no músculo trapézio superior e abertura mandibular em indivíduos com bruxismoObjectives: To compare the effects of three different physical therapy interventions with dental treatment in the pain and symptoms, mandibular opening, anxiety, stress, depression, oral health and sleep in individuals with bruxism. Methods: Ninety-six individuals with pain and awake and sleep bruxism and 18-60 years old were allocated to the one of four groups: Group 1: massage and stretching exercises (n=24), Group 2: relaxation therapy and imagination (n=24), Group 3: massage, exercises, relaxation and imagination (n=24) or Group 4: dental treatment by the direct restoration (n=24). Primary outcomes included muscle pain and symptoms (intensity measured using a visual analogue scale and pain threshold with algometry) and mandibular opening (measured using a digital pachymeter). Secondary outcomes included anxiety (state-trait anxiety inventory), stress (perceived stress scale), depression (Beck depression inventory), oral health (oral health impact profile-14), and sleep quality (Pittsburgh sleep quality index). Outcomes were evaluated at baseline, 6 weeks and 2 months post-initial intervention by the blinded assessor. Physical therapy interventions included individual sessions that lasted 40 min biweekly for 6 weeks and dental treatment, two 2-h individual sessions conducted a week apart. The level of significance established was alfa=5%. Results: At 6 weeks after, the improvement with difference among Groups 1, 2, 3 and Group 4 was observed in masseter muscle pain [Mean Difference=2.3 / 2.7 / 5.5 (95%CI=0.2 to 4.4 / 0.9 to 4.4 / 3.8 to 7.2)], anterior temporalis [Mean Difference=2.6 / 2.1 / 5 (95%CI=0.5 to 4.7 / 0.1 to 4.1 / 3.2 to 6.7)], sternocleidomastoid [Mean Difference=3.3 / 4.2 / 6.1 (95%CI=1.6 to 4.9 / 2.6 to 5.8 / 4.6 to 7.5)] and upper trapezius [Mean Difference=3.8 / 4.1 /6.6 (95%CI=2.1 to 5.5 / 2.3 to 5.5 / 5.4 to7.7)] as well as in symptoms of headache, teeth clenching and sleep difficulties, anxiety state, stress, depression and sleep quality (p 0.05), respectively. Conclusions: The results suggest that three physical therapy interventions compared to dental treatment reduce the pain and symptoms and indicate improvement of anxiety, stress, depression and sleep quality. Moreover, the date demonstrate that both combined physical therapy interventions (massage, exercises, relaxation and imagination) as isolated (relaxation therapy and imagination) improve the oral health and only the combined increases the mandibular opening and pain threshold of upper trapezius muscle in individuals with bruxis