Comparison between Trans-Cranial Electromagnetic Stimulation and Low-Level Laser on Modulation of Trigeminal Neuralgia

Abstract

[Purpose] To determine which of the transcranial electromagnetic stimulation or low level laser therapy is more effective in the treatment of trigeminal neuralgia of multiple sclerosis patients. [Methods] Thirty multiple sclerosis patients of both sexes participated in this study. The age of the subjects ranged from 40 to 60 years and their mean age was (56.4–6.6). Participants were randomly selected from Dental and Neurology Outpatient Clinics at King Khalid Hospital, Najran University, Saudi Arabia. Patients were randomly divided into two equal groups of 15. The Laser group received a low level laser therapy, 830 nm wavelength, 10 Hz and 15 min duration, while the Electromagnetic group received repetitive transcranial electromagnetic stimulation at a frequency of 10 Hz, intensity of 50 mA and duration of 20 minutes. Patients were assessed pre and post treatment for degree of pain using a numerical rating scale, maximal oral mouth opening using a digital calibrated caliper, masseter muscle tension using a tensiometer and a compound action potentials of masseter and temporalis muscles. [Results] There were significant improvements after treatment in both groups, with a significant difference between the Electromagnetic and Laser groups, in favor of the Electromagnetic group. [Conclusion] Repetitive transcranial electromagnetic stimulation at 10 Hz, 50 mA, and 20 minutes duration is more effective than low level laser therapy at reducing trigeminal pain, increasing maximum oral mouth opening, masseter and temporalis muscle tension in multiple sclerosis patients.

Non-invasive brain stimulation techniques for chronic pain

“…Three of these studies did not randomly allocate participants to groups (Cummiford 2016; Lindholm 2015; Yoon 2014). Six were not clearly in a chronic population (Bolognini 2015; Choi 2014; Khedr 2005; Ma 2015; Morin 2017; Schabrun 2014), two were not studies of electrical brain stimulation (Maestu 2013; Smania 2005), one did not employ a sham control (Seada 2013).…”

“…May not be exclusively chronic painBelci 2004Pain is not measured as an outcomeBolognini 2013Inclusion of acute and chronic pain patientsBolognini 2015Not clearly a chronic populationCarraro 2010Not a study of electrical brain stimulationChoi 2012bStudy of acute painChoi 2012aStudy of acute painChoi 2014Not clearly a chronic populationCummiford 2016Allocation not randomisedEvtiukhin 1998A study of postoperative pain. No sham control employedFrentzel 1989Not a study of brain stimulationHargrove 2012bUncontrolled long‐term follow‐up data from Hargrove 2012aJohnson 2006Self‐reported pain is not measuredKatz 1991Study not confined to chronic painKhedr 2015Not clearly a chronic populationLindholm 2015Allocation not randomisedLongobardi 1989Not clearly studying chronic painMa 2015Not clearly a chronic populationMaestu 2013Not electrical brain stimulation ‐ magnetic fields unlikely to induce electrical currentsMorin 2017Not clearly a chronic pain population ‐ provoked vestibulodyniaNelson 2010Intervention not designed to alter cortical activity directly by electrical stimulation ‐ a neuro feedback interventionO'Connell 2013Not a RCT or quasi‐RCT ‐ no randomisation specifically to treatment group or orderPujol 1998Participants are a mixture of acute and chronic pain patientsSchabrun 2014Not clearly a chronic populationSeada 2013No sham control employed…”

Paroxysmal Symptoms in Multiple Sclerosis—A Review of the Literature

“…Neuromodulation offers an alternative for patients with TN refractory to pharmacotherapy. Options include transcranial electromagnetic stimulation, low level laser and peripheral nerve field stimulation [ 72 , 73 ]. Posterior hypothalamic deep brain stimulation was only found effective in ophthalmic division pain [ 74 ].…”

Neuralgia do trigêmeo: uma revisão integrativa acerca da clí­nica médica, cirúrgica e fisioterapêutica

“…O estudo de Seada et al compara a estimulação eletromagnética transcraniana repetitiva (EMTr) de 10 Hz, intensidade de 50 mA e o laser hélio-neon de 830 nm, 10 Hz no tempos de 20 e 15 minutos, respectivamente, durante vinte e quatro sessões, divididas em três dias por oito semanas, em dois grupos de 15 sujeitos, cada, com neuralgia do trigêmeo em decorrência de esclerose múltipla [33]. Esses autores puderam observar a eficácia das duas técnicas no nível de dor, abertura da boca e tensionamento dos músculos masseter e temporal em ambos os grupos, porém os que utilizaram a EMTr tiveram resultados mais significativos se comparado aos que fizeram uso do laser de baixa potência, sendo ainda considerada uma modalidade mais útil e segura do que fármacos para outros distúrbios orofaciais como síndrome da dor miofacial, dores odontogênicas e disfunção temporomandibulares.…”