title: Effect of burst TENS and conventional TENS combined with cryotherapy on pressure pain threshold: randomised, controlled, clinical trial.
abstract: OBJECTIVE
  To assess the immediate effect of conventional and burst transcutaneous electrical nerve stimulation (TENS) in combination with cryotherapy on pain threshold and tolerance in healthy individuals.
  
  
  METHODS
  Randomised, controlled trial.
  
  
  METHODS
  University laboratory.
  
  
  METHODS
  One hundred and twelve healthy women.
  
  
  METHODS
  Volunteers were allocated at random to seven groups (n=16): (1) control, (2) placebo TENS, (3) conventional TENS, (4) burst TENS, (5) cryotherapy, (6) cryotherapy in combination with burst TENS, and (7) cryotherapy in combination with conventional TENS. Pain threshold and tolerance were measured by applying a pressure algometer at the lateral epicondyle of the humerus, before and after each intervention.
  
  
  METHODS
  The primary outcome measure was pressure pain threshold.
  
  
  RESULTS
  A significant increase in pain threshold and tolerance at the 5% level of significance was recorded as follows: burst TENS {pain threshold: mean difference 1.3 [95% confidence interval (CI) 1.4 to 1.2]; pain tolerance: mean difference 3.8 (95% CI 3.9 to 3.7)}, cryotherapy [pain threshold: mean difference 1.3 (95% CI 1.4 to 1.2); pain tolerance: mean difference 1.9 (95% CI 1.8 to 2.0)] and cryotherapy in combination with burst TENS [pain threshold: mean difference 2.6 (95% CI 2.4 to 2.8); pain tolerance: mean difference 4.9 (95% CI 5.0 to 4.8)]. Cryotherapy in combination with burst TENS provided greater analgesia compared with the other groups (P<0.001).
  
  
  CONCLUSIONS
  These results support the use of cryotherapy in combination with burst TENS to reduce induced pain, and suggest a potentiating effect when these techniques are combined. No such association was found between cryotherapy and conventional TENS.
authors.affiliation: Department of Physiotherapy, Federal University of Rio Grande do Norte, Laboratório de Análise da Performance Neuromuscular, Natal, RN, Brazil.
authors.forename: L B
authors.initials: LB
authors.lastname: Macedo
authors.affiliation: Department of Physiotherapy, Federal University of Rio Grande do Norte, Laboratório de Análise da Performance Neuromuscular, Natal, RN, Brazil.
authors.forename: A M
authors.initials: AM
authors.lastname: Josué
authors.affiliation: Department of Physiotherapy, Federal University of Rio Grande do Norte, Laboratório de Análise da Performance Neuromuscular, Natal, RN, Brazil.
authors.forename: P H B
authors.initials: PH
authors.lastname: Maia
authors.affiliation: Department of Physiotherapy, Federal University of Rio Grande do Norte, Laboratório de Análise da Performance Neuromuscular, Natal, RN, Brazil.
authors.forename: A E
authors.initials: AE
authors.lastname: Câmara
authors.affiliation: Department of Physiotherapy, Federal University of Rio Grande do Norte, Laboratório de Análise da Performance Neuromuscular, Natal, RN, Brazil. Electronic address: brasileiro@ufrnet.br.
authors.forename: J S
authors.initials: JS
authors.lastname: Brasileiro
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000379:methods*; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D010147:Pain Measurement; D017288:Pain Threshold; D026741:Physical Therapy Modalities; D011312:Pressure; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D055815:Young Adult
keywords: Analgesia; Electrotherapy; Ice