Trans-cutaneous electrical nerve stimulation to treat dry mouth (xerostomia) following radiotherapy for head and neck cancer. A systematic review

Abstract

Background A dry mouth or xerostomia is one of the most common long-term complications following radiotherapy for head and neck cancer and has a negative impact on quality of life in cancer survivors. Transcutaneous electrical nerve stimulation (TENS) is a novel approach to improving saliva flow in these patients. Objective To perform a systematic review of studies evaluating TENS in the treatment of radiotherapy induced xerostomia in head and neck cancer patients. Data collection and analysis A comprehensive electronic search was performed in PubMed/MEDLINE, the Cochrane Library, and Google Scholar databases for appropriate published studies. The last search was conducted in January 2020. Two review authors assessed all studies identified by the search strategy and carried out data extraction. Results Five studies were included in the systematic review which analysed a total of 280 patients with head and neck cancer. Methodological quality and outcomes were evaluated in every study included. The outcome measure was either subjectively assessed or objectively measured. Three studies used conventional TENS therapy to stimulate parotid glands which produced a significant increase in saliva production following therapy. Two studies used acupunctured TENS type to electrically stimulate acupuncture points scattered in the body and they reported improvement in saliva production at the same level as medical treatment. No reported adverse effect of TENS was identified. Conclusions This systematic review confirms the safety and feasibility of TENS in the treatment of xerostomia. It is established that commencing daily TENS therapy simultaneously with radiotherapy has the most efficacy. Given the nonspecific parameters used in the included studies, further evidence is needed in order to establish optimal settings and parameters of TENS for treatment of xerostomia.

Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines, Sixth Edition

“…Clinical trials of transcutaneous electrical nerve stimulation devices and intra-oral electrostimulators have reported increased saliva secretion and possible reductions in dry mouth symptoms, although the evidence is limited by differences and inconsistencies in terms of the duration and type of electrical stimulation used, as well as the study design. 653 No serious adverse events have been reported with the use of available salivary neuro-electrostimulating devices.…”

Manejo odontológico de las manifestaciones orales inducidas por radioterapia de cabeza y cuello

“…Cuando la capacidad secretora residual de las glándulas salivales aún está presente, puede ser apropiada la estimulación de la secreción salival 46 . Entre las opciones reportadas en la literatura están los fármacos parasimpaticomiméticos, la acupuntura, la fitoterapia, la estimulación nerviosa y la PBMT 38,[45][46][47][48][49][50][51][52][53][54][55][56][57][58] .…”

“…La estimulación nerviosa eléctrica transcutánea (TENS, por sus siglas en inglés) es una técnica no invasiva que transmite corrientes eléctricas sobre la superficie intacta de la piel con el fin de activar los nervios subyacentes. Se ha propuesto como terapia prometedora para la xerostomía ya que logra estimular la función salival 53 . Existen dos tipos de TENS: la TENS convencional que consiste en la estimulación local de las glándulas salivales y la TENS similar a la acupuntura que consiste en la estimulación a distancia 53,54 .…”

“…Se ha propuesto como terapia prometedora para la xerostomía ya que logra estimular la función salival 53 . Existen dos tipos de TENS: la TENS convencional que consiste en la estimulación local de las glándulas salivales y la TENS similar a la acupuntura que consiste en la estimulación a distancia 53,54 . Estudios han demostrado que ambos tipos de TENS son eficaces y seguros para disminuir la xerostomía inducida por radioterapia 55,56 .…”

Diagnosis, Prevention, and Treatment of Radiotherapy-Induced Xerostomia: A Review

“…Though these studies have revealed some positive effects, the evidence is insufficient. The instruments need to be refined in shape and material to provide the appropriate electrical impulse to activate the nerves [ 122 , 123 ].…”