Comparison of analgesic effect of piroxicam and transcutaneous electrical nerve stimulation therapy on pain associated with orthodontic separator placement: A single blind randomized controlled trial

Aims and objectives: To assess and compare the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy and preemptive piroxicam administration in reducing the severity of pain after orthodontic separator placement. Materials and methods: It was a randomized, single-blind, parallel arm trial. Subjects of either gender between 18 and 30 years of age, scheduled to undergo regular orthodontic therapy with placement of two separators in each arch, were selected for this trial. The sample size consisted of 60 patients from whom prior informed consent was obtained. They were assigned randomly into two categories of 30 subjects each. • Group I: Subjects were given piroxicam (20 mg) 1 hour before separator placement. • Group II: Subjects were given TENS therapy immediately after separator placement. The treatment was administered by the coinvestigator, so as to blind the principal investigator to the treatment group. Perceived pain was evaluated on chewing and fitting back teeth together at 2-, 6-, 24-, and 48-hour intervals, using the visual analog scale (VAS). Results: Descriptive statistical analysis revealed that the VAS scores in the piroxicam group were marginally higher than the TENS group at all intervals, except at 2 hours. The difference was, however, statistically insignificant. Conclusion: The findings of this single blind randomized, controlled trial (RCT) suggest that TENS therapy is as effective as 20 mg piroxicam administered preemptively, in controlling pain felt due to separator placement. The TENS offers several advantages over piroxicam, as it is devoid of the inherent side effects of nonsteroidal antiinflammatory drugs (NSAIDs) like an inhibitory effect on orthodontic tooth movement and also gastric irritation. Therefore, the use of TENS is recommended over NSAIDs for the successful management of orthodontic pain, which is so critical both from the patient’s and from the clinician’s perspective.