postoperative pain

JADA, Vol. 133, May 2002643input from large pain-conducting nerve fibers results in closing the gate on nocicep-tive sensory phenomena from the A-delta fibers and C fibers.TENS, therefore, blocks ascen-dance of nociceptive phenomena,which prevents descendent motor activity (tightening up).Also, by providing stimulating muscular contraction, thepumping action of TENS results in increased tissue perfusion.Pain symptoms after dental treatment most commonly are referable to structures inner-vated by the trigeminal nerve;these structures include, but are not limited to, muscles (mas-seter, temporalis, lateral ptery-goid, medial pterygoid), tendons (temporal) and ligaments (stylo-mandibular), which can be stretched to or beyond their modulus of elasticity or held in nonphysiological positions by prolonged opening. When we use TENS, we apply it over the coro-noid notch, which closelyapproximates the level at which the trigeminal nerve exits the skull. When TENS is applied inCopyright ©2002 American Dental Association. All rights reserved.644JADA, Vol. 133, May 2002Patients for whom TENS use would be contraindicatedinclude patients who have car-diac pacemakers, neurological disorders —such as stroke or epilepsy —or are pregnant.Patients with histories ofchronic posterior cervical neck pain or occipital headache also should not receive TENS treat-ment that is confined to the trigeminal region, as the untreated condition may be exacerbated.When we identify patients who meet the use criteria, we use TENS as a prophylactic measure for subsequent treat-ment. We have used this tech-nique on at least 60 patients and none has developed postopera-tive pain or trismus when it is used.A wide variety of TENS units are available, and even elec-troanalgesic units can be used for this purpose. A typical TENS unit (Figure 1) can be used quickly and easily by following these steps:d Cleanse the surfaces over the coronoid notches bilaterally with alcohol wipes to remove makeup and facial oils. Then dry theareas with clean pieces of gauze.d Apply self-adherent electrode patches over the cleansed areas.d Make sure the TENS unit ’s amplitude controls are set to the “off ” position.d Attach the electrode leads from the patch to the TENS unit (Figure 2). If a dual-channel machine is used, it does not matter which channel is selected.d Set the timer to C (contin-uous) and the mode selector to C (conventional).d Adjust the controls to a high bandwidth and relatively high frequency.d Switch on the appropriateCopyright ©2002 American Dental Association. All rights reserved.supply houses. After use, theelectrode patches can bereplaced on the original plastic-coated backing, stored in aplastic bag and reused by thesame patient during subsequentappointments.We recommend this techniqueas a safe, relatively inexpensiveway of preventing posttreatmentdiscomfort caused by prolongeddental treatment. In our experi-ence, this technique has beenuniformly successful and resultsin patients who more readilyaccept dental treatment.sDr. Herman is an associate professor, Med-ical College of Georgia, Georgia’s Health Sci-ences University, School of Dentistry, OralDiagnosis and Patient Services, Augusta, Ga.,30912-1241, e-mail “wherman@”.Address reprint requests to Dr. Herman.Dr. Konzelman is a professor, Medical Col-lege of Georgia, Georgia’s Health SciencesUniversity, School of Dentistry, Oral Diag-nosis and Patient Services, Augusta.Dr. Comer is associate dean for patient ser-vices and department chair, Medical College ofGeorgia, Georgia’s Health Sciences University,School of Dentistry, Oral Diagnosis andPatient Services, Augusta.1. Malamed SF. Future trends in pain con-trol. In: Handbook of local anesthesia. 4th ed.St. Louis: Mosby; 1997:287-302.2. Murphy GJ. Utilization of transcutaneouselectrical nerve stimulation in managing cran-iofacial pain. Clin J Pain 1990;6:64-9.3. Meechan JG, Gowans AJ, Welbury RR.The use of patient-controlled transcutaneouselectronic nerve stimulation (TENS) todecrease the discomfort of regional anaes-thesia in dentistry: a randomised controlledclinical trial. J Dent 1998;26:417-20.4. Harvey M, Elliott M. Transcutaneous elec-trical nerve stimulation (TENS) for pain man-agement during cavity preparations in pedi-atric patients. ASDC J Dent Child1995;62:49-51.5. Clark MS, Silverstone LM, Lindenmuth J,et al. An evaluation of the clinicalanalgesia/anesthesia efficacy on acute painusing the high frequency neural modulator invarious dental settings. Oral Surg Oral MedOral Pathol 1987;63:501-5.6. Melzack R, Wall PD. Pain mechanisms: anew theory. Science 1965;150:971-9.JADA, Vol. 133, May2002645 Copyright ©2002 American Dental Association. All rights reserved.。