Immediate analgesic effect of two modes of transcutaneous electrical nerve stimulation on patients with chronic low back pain: a randomized controlled trial

Abstract

Objective: To compare and assess the immediate analgesic effects of conventional and burst transcutaneous electrical nerve stimulation in patients with chronic low back pain. Methods: We conducted a three-arm single-blinded randomized controlled trial. A total of 105 patients with non-specific chronic low back pain aged between 18 and 85 years were randomly assigned into the following groups: Placebo Group (sham electrical stimulation), Conventional TENS Group (continuous stimulation at 100Hz for 100µs with sensory intensity), and Burst TENS Group (stimulation at 100Hz modulated at 2Hz for 100µs with motor-level intensity). All groups received a single application of transcutaneous electrical nerve stimulation for 30 minutes. The outcomes, namely, pain intensity, quality of pain, and pressure pain threshold were measured by the visual analog scale, McGill pain questionnaire, and algometry, respectively. The patients were evaluated before and immediately after the transcutaneous electrical nerve stimulation application. Results: Pain intensity (visual analog scale score) and quality of pain (McGill pain questionnaire score) significantly decreased (p<0.05) in Intervention Groups (Conventional TENS Group and Burst TENS Group). A positive effect was observed in the interventions compared to the Placebo Group in all domains of the McGill pain questionnaire (p<0.05), excepting for the pain intensity. Pressure pain threshold significantly increased (p<0.05) immediately after the transcutaneous electrical nerve stimulation application in both Intervention Groups, but not in the Placebo Group. For significant difference was found during assessment when comparing both Intervetion Group. Conclusion: Both transcutaneous electrical nerve stimulation modes were effective for pain modulation. Moreover, there was an increase in the pressure pain threshold. No significant results were found to indicate the best mode for the treatment of chronic low back pain.

Thoracolumbar fascia in the lumbar region: anatomical description and topographical relationships to the cutaneous nerves: a preliminary study

“…Knowledge of cutaneous nerve topography can also be helpful in the application of noninvasive physiotherapy treatments in the case of low back pain. For instance, transcutaneous electrical nerve stimulation was proved effective for pain modulation [17]. Knowledge of lumbar dorsal rami may also be crucial for lumbar erector spinae plane block [6,8,9,11,14,18].…”

Tratamento de lombalgia crônica em pacientes obesos

“…Já quando o modo aplicado consiste em baixa frequência o efeito desejado consiste na despolarização das fibras de dor rápida buscando, dessa forma, a ativação da analgesia por via descendente. Importante ressaltar, ainda, que independente do modo da EETN, quando o estímulo é aplicado, ocorre a ativação de receptores opioides no sistema nervoso central aumentando o limiar de dor e provocando uma maior analgesia (Pivovarsky et al, 2021;Calou et al, 2021).…”

Efficacy of a conservative physical treatment regimen on psychological status and quality of life in Greek patients with chronic low back pain

“…[10][11][12] Specifically, previous studies have shown that single and mainly combined use of transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (US), massage, low-level laser, and exercise are effective not only in improving health and psychological status but also in alleviating pain severity and functional disability. [11][12][13][14][15][16][17][18] However, the clinical effect of the aforementioned intervention has not been documented beyond a reasonable doubt. In particular, a systematic review of eighty-three randomized controlled trials identified ambiguous evidence to support the effectiveness of conventional physical treatment for patients with CLBP, concluding that additional trials should be carried out to better comprehend and evaluate its efficacy.…”