{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:44:02Z","timestamp":1792691042080,"version":"4.5.0"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Coordination for the Improvement of Higher Education Personnel","award":["Finance Code 001"],"award-info":[{"award-number":["Finance Code 001"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Postoperative pain after cesarean section may delay recovery and impair function. Transcutaneous electrical nerve stimulation (TENS) and low-level laser photobiomodulation (PBM) are used for pain control, but the additional effect of combining these therapies remains unclear. This study investigated this effect.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A randomized clinical trial with four groups: combined TENS\u2009+\u2009low-level laser photobiomodulation (PBM), TENS alone, placebo, and control. Assessments were performed at 8\u201312 h (t1), 20\u201324 h (t2), and 44\u201348 h postpartum (t3). Outcomes included pain intensity, functional independence, functional capacity assessed by the Two-Minute Walk Test (2MWT), and cardiorespiratory variables. Two intervention sessions were applied after t1 and t2, except in the control group. Data were analyzed using mixed ANOVA and nonparametric equivalents when appropriate. Statistical significance was set at p\u2009&lt;\u20090.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 88 women were included. Pain intensity decreased significantly over time in the combined TENS\u2009+\u2009PBM group (1.82\u2009\u00b1\u20091.18 at t2 vs 1.30\u2009\u00b1\u20090.86 at t3; p\u2009=\u20090.008) and in the TENS group (1.59\u2009\u00b1\u20091.05 at t2 vs 0.95\u2009\u00b1\u20091.05 at t3; p\u2009=\u20090.025). Functional independence increased in the combined therapy group (14.9\u2009\u00b1\u20093.3 at t1 vs 17.1\u2009\u00b1\u20093.6 at t3; p\u2009=\u20090.034) and in the TENS group (15.2\u2009\u00b1\u20093.0 at t1 vs 17.5\u2009\u00b1\u20093.4 at t3; p\u2009=\u20090.028). Functional capacity improved in all groups between t2 and t3 in the Two-Minute Walk Test (Control: 63.5 vs 76.8 m, p\u2009=\u20090.002; Placebo: 50.3 vs 63.9 m, p\u2009=\u20090.002; Combined: 48.3 vs 65.2 m, p\u2009=\u20090.0006; TENS: 61.1 vs 72.2 m, p\u2009=\u20090.005). No significant differences were observed between groups (p\u2009&gt;\u20090.05). A significant time effect was found for pain (p\u2009&lt;\u20090.05) and functional independence (p\u2009&lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pain decreased and functional independence improved during the postoperative period. However, the combination of TENS and low-level laser photobiomodulation did not provide additional benefits compared with the other groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360761","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:30:52Z","timestamp":1792690252000},"page":"e0360761","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Combined transcutaneous electrical nerve stimulation and low-level laser photobiomodulation for postoperative pain after cesarean section: A randomized controlled trial"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3832-8808","authenticated-orcid":true,"given":"Alane Macatr\u00e3o Pires","family":"de Holanda Ara\u00fajo Sena","sequence":"first","affiliation":[{"name":"Postgraduate Program in Physiotherapy (PPGFIS), Federal University of Rio Grande do Norte (UFRN)","place":["Natal, Rio Grande do Norte, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan Daniel Bezerra","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Federal University of Rio Grande do Norte (UFRN)","place":["Natal, Rio Grande do Norte, Brazil"],"department":["Department of Physical Therapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K\u00e1ssio Rafael Rocha de","family":"Sena","sequence":"additional","affiliation":[{"name":"Faculdade Est\u00e1cio de Natal","place":["Natal, Rio Grande do Norte, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00cdllia Nadinne Dantas Florentino","family":"Lima","sequence":"additional","affiliation":[{"name":"Federal University of Rio Grande do Norte (UFRN)","place":["Natal, Rio Grande do Norte, Brazil"],"department":["Department of Physical Therapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3763-2410","authenticated-orcid":true,"given":"Patr\u00edcia Ang\u00e9lica de Miranda Silva","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Federal University of Rio Grande do Norte (UFRN)","place":["Natal, Rio Grande do Norte, Brazil"],"department":["Department of Physical Therapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"issue":"2","key":"pone.0360761.ref001","doi-asserted-by":"crossref","first-page":"169","DOI":"10.5606\/tftrd.2020.3225","article-title":"The efficacy of transcutaneous electrical nerve stimulation therapy in pain control after cesarean section delivery associated with uterine contractions and abdominal incision","volume":"66","author":"I Kasapo\u011flu","year":"2020","journal-title":"Turk J Phys Med 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Pilch","year":"2024","journal-title":"Eur J Midwifery"},{"issue":"6","key":"pone.0360761.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0325254","article-title":"TENS alone or combined with low-level laser therapy photobiomodulation for pain, functional capacity, and cardiorespiratory physiological variables after cesarean section: Protocol for a randomized clinical trial","volume":"20","author":"AMP de Holanda Ara\u00fajo Sena","year":"2025","journal-title":"PLoS One"},{"issue":"3","key":"pone.0360761.ref013","doi-asserted-by":"crossref","first-page":"204","DOI":"10.48095\/cccg2025204","article-title":"Effectiveness of physiotherapy on pain relief and functional recovery post-cesarean section","volume":"90","author":"S Ostafiichuk","year":"2025","journal-title":"Ceska Gynekol"},{"issue":"5","key":"pone.0360761.ref014","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1111\/jmwh.13625","article-title":"The effects of transcutaneous electrical nerve stimulation applied in the early postpartum period after cesarean birth on healing, pain, and comfort","volume":"69","author":"E Sabanc\u0131 Baransel","year":"2024","journal-title":"J Midwifery Womens Health"},{"issue":"1","key":"pone.0360761.ref015","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1186\/s12884-023-06159-3","article-title":"Functional recovery after cesarean delivery: A prospective cohort study in rural Rwanda","volume":"23","author":"A Niyigena","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"issue":"2","key":"pone.0360761.ref016","doi-asserted-by":"crossref","first-page":"427","DOI":"10.3390\/jcm13020427","article-title":"The impact of transcutaneous electrical nerve stimulation (TENS) on acute pain and other postoperative outcomes: A systematic review with meta-analysis","volume":"13","author":"D Viderman","year":"2024","journal-title":"J Clin 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