Contents lists available at ScienceDirect Journal of Communication Disorders journal homepage: www.elsevier.com/locate/jcomdis Effects of transcutaneous electrical nervous stimulation (TENS) associated with vocal therapy on musculoskeletal pain of women with behavioral dysphonia: A randomized, placebo-controlled double-blind clinical trial Larissa Thais Donalonso Siqueira a , Vanessa Veis Ribeiro b , Pamela Aparecida Medeiros Moreira c , Alcione Ghedini Brasolotto c , Rinaldo Roberto de Jesus Guirro d , Kelly Cristina Alves Silverio c, ⁎ a Universidade Estadual do Centro-Oeste – UNICENTRO, Irati, Paraná, Brazil b Centro Universitário do Cerrado Patrocínio – UNICERP, Patrocínio, Minas Gerais, Brazil c Disorders Department of the Faculdade de Odontologia de Bauru/Universidade de São Paulo – FOB/USP, Bauru, São Paulo, Brazil d Faculdade de Medicina de Ribeirão Preto/Universidade de São Paulo – FMRP/USP, Ribeirão Preto, São Paulo, Brazil ARTICLE INFO Keywords: Voice Voice training Transcutaneous electric nerve stimulation ABSTRACT Recently, electrical stimulation in vocal rehabilitation has been the subject of studies. This treatment has shown promising results regarding the decrease of vocal/laryngeal symptoms, pain and the improvement of vocal tension. In addition to decreasing pain symptoms, TENS treat- ments may lead to muscle relaxation. There is no data on the effects of this resource as a vocal therapy in women with behavioral dysphonia. Research in this area may provide evidence to assist the clinical decision related to the treatment of women with complaints of behavioral dysphonia and musculoskeletal pain. Objective: To verify the effects of low-frequency TENS in association with vocal therapy on musculoskeletal pain in women with behavioral dysphonia. Methods: Participants included 27 women with vocal nodules randomized into two groups. The experimental group (EG) - 13 women received 12 sessions of TENS (pulse of 200 μs, frequency at 10 Hz, in motor threshold) with electrodes placed bilaterally on the trapezius muscle and sub- mandibular area for 20 min followed by 30 min of vocal therapy, and the control group (CG) - 14 women received 12 sessions of 20 min of a placebo TENS followed by 30 min of vocal therapy. We investigated the frequency and intensity of the musculoskeletal pain in several body regions, as well as the intensity of pain at rest and in the application of pressure with an algometer applied to the descending fibers of the trapezius muscle. The pressure-pain threshold (PPT) was also investigated. All evaluations occurred before, immediately after, and at one and three months after treatment in both groups. Results: We observed a reduction in the frequency of pain in the larynx after treatment of both groups, but only the EG showed a decrease in pain intensity in this region. It was verified with an algometer to the trapezius muscle that the electrical stimulation associated with the vocal therapy decreased the intensity of pain during the application of pressure and increased the PPT. https://doi.org/10.1016/j.jcomdis.2019.105923 Received 26 April 2018; Received in revised form 27 May 2019; Accepted 25 July 2019 ⁎ Corresponding author at: Department of Speech Hearing and Language Disorders – Bauru School of Dentistry/University of São Paulo, Al. Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil. E-mail addresses: larisiqueira_4@hotmail.com (L.T.D. Siqueira), fgavanessavr@gmail.com (V.V. Ribeiro), pamela_moreria15@yahoo.com.br (P.A.M. Moreira), alcione@usp.br (A.G. Brasolotto), rguirro@fmrp.usp.br (R.R. de Jesus Guirro), kellysilverio@usp.br (K.C. Alves Silverio). Journal of Communication Disorders 82 (2019) 105923 Available online 30 July 2019 0021-9924/ © 2019 Elsevier Inc. All rights reserved. T