title: Sensory trigeminal ULF-TENS stimulation reduces HRV response to experimentally induced arithmetic stress: A randomized clinical trial.
abstract: Ultra Low Frequency Transcutaneous Electric Nervous Stimulation (ULF-TENS) is extensively used for pain relief and for the diagnosis and treatment of temporomandibular disorders (TMD). In addition to its local effects, ULF-TENS acts on the autonomic nervous system (ANS), with particular reference to the periaqueductal gray (PAG), promoting the release of endogenous opioids and modulating descending pain systems. It has been suggested that the PAG participates in the coupling between the emotional stimulus and the appropriate behavioral autonomic response. This function is successfully investigated by HRV. Therefore, our goal is to investigate the effects of trigeminal ULF-TENS stimulation on autonomic behavior in terms of HRV and respiratory parameters during an experimentally-induced arithmetic stress test in healthy subjects. Thirty healthy women between 25 and 35years of age were enrolled and randomly assigned to either the control (TENS stimulation off) or test group (TENS stimulation on). Heart (HR, LF, HF, LF/HF ratio, DET, RMSSD, PNN50, RR) and respiratory (BR) rate were evaluated under basal, T1 (TENS off/on), and stress (mathematical task) conditions. Results showed that HRV parameters and BR significantly changed during the arithmetic stress paradigm (p<0.01). Independently of stress conditions, TENS and control group could be discriminated only by non-linear HRV data, namely RR and DET (p=0.038 and p=0.027, respectively). During the arithmetic task, LF/HF ratio was the most sensitive parameter to discriminate between groups (p=0.019). Our data suggest that trigeminal sensory ULF-TENS reduces the autonomic response in terms of HRV and BR during acute mental stress in healthy subjects. Future directions of our work aim at applying the HRV and BR analysis, with and without TENS stimulation, to individuals with dysfunctional ANS among those with TMD.
authors.affiliation: University of L'Aquila, Department of Life, Health and Environmental Sciences, Division of Dentistry, Building Delta 6, St Salvatore Hospital, Via Vetoio, 67100 L'Aquila, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Monaco
authors.affiliation: University of L'Aquila, Department of Life, Health and Environmental Sciences, Division of Dentistry, Building Delta 6, St Salvatore Hospital, Via Vetoio, 67100 L'Aquila, Italy.
authors.forename: Ruggero
authors.initials: R
authors.lastname: Cattaneo
authors.affiliation: University of L'Aquila, Department of Life, Health and Environmental Sciences, Division of Dentistry, Building Delta 6, St Salvatore Hospital, Via Vetoio, 67100 L'Aquila, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Ortu
authors.affiliation: Faculty of Dental Medicine, "Titu Maiorescu" University of Bucharest, Bucharest, Romania.
authors.forename: Marian Vladimir
authors.initials: MV
authors.lastname: Constantinescu
authors.affiliation: University of L'Aquila, Department of Life, Health and Environmental Sciences, Division of Dentistry, Building Delta 6, St Salvatore Hospital, Via Vetoio, 67100 L'Aquila, Italy. Electronic address: davide.pietropaoli@univaq.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Pietropaoli
mesh_terms: D000328:Adult; D004576:Electromyography; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D064368:Healthy Volunteers; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008433:Mathematics; D012119:Respiration; D013315:Stress, Psychological / Q000209:etiology* / Q000628:therapy*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D014276:Trigeminal Nerve / Q000502:physiology*; D064232:Visual Analog Scale
keywords: Experimental stress; Heart rate variability; Randomized clinical trial; Transcutaneous electric nervous stimulation; Trigeminus