Análise comparativa da associação da tens com o método pilates na lombalgia crônica: ensaio clínico aleatorizado, sham-controlado e duplo-cego

Abstract

Introduction: Chronic low back pain is one of the leading causes of disability worldwide, generating significant impacts on quality of life and imposing a heavy burden on healthcare systems. Among the most widely used physiotherapeutic approaches for managing this condition, Pilates and Transcutaneous Electrical Nerve Stimulation (TENS) stand out. Despite the widespread use of both interventions, evidence on the possible synergistic effects of their simultaneous application remains scarce. Thus, the aim of this study was to investigate the effects of adding TENS to a Pilates protocol on pain intensity and functional capacity outcomes in individuals with chronic low back pain. Methods: A randomized, sham-controlled, double-blind clinical trial was conducted with 101 individuals with chronic low back pain, allocated into two groups: Pilates combined with active TENS (n = 49) and Pilates combined with sham TENS (n = 52). Participants underwent 12 floor-based exercise sessions, following the principles of the Pilates Method, performed twice a week over a 6-week period. The participants were divided into two groups: one receiving active TENS (100 Hz, 100 μs, strong intensity) and the other receiving sham TENS during the entire Pilates session. Pain intensity (measured using the Numeric Pain Rating Scale) and functional capacity (measured using the Roland-Morris Disability Questionnaire) were assessed before the treatment protocol (T0), immediately after the first session (T1), and after 12 sessions (T2), while participants’ perception of improvement and satisfaction with the treatment (measured using the Global Perceived Effect Scale) was assessed at the end of the protocol (T2). Data were analyzed using repeated-measures ANOVA with Bonferroni post hoc tests and independent samples t-tests, using SPSS v.25 software. Results: Both groups showed a significant reduction in pain after the first session, with improvement maintained until the 12th session. In the PILATENS group, pain intensity decreased from 6.02 (±1.95) to 1.61 (±2.01) (p < 0.001); in the SHAM group, from 6.46 (±1.81) to 2.40 (±2.49) (p < 0.001). Repeated-measures ANOVA indicated a significant time effect on pain (p < 0.001), with no difference between groups (p = 0.21). Functional capacity also improved significantly: in the PILATENS group, Roland-Morris scores decreased from 6.33 (±4.63) to 2.35 (±3.18), and in the SHAM group, from 6.31 (±4.91) to 3.21 (±3.59). The within-group differences were statistically significant (p < 0.001), but there was no significant difference between groups (p = 0.308). Both groups also reported positive perceptions regarding clinical improvement and satisfaction with treatment, with the PILATENS group showing a significantly higher mean score (5.90 ± 1.23) than the SHAM group (5.21 ± 1.49) (p = 0.013). Conclusion: Adding TENS to Pilates did not provide additional benefits in reducing pain or improving functional capacity in individuals with chronic low back pain. These results highlight the importance of the rational use of therapeutic resources and encourage further research on treatment combinations.