A Controlled Trial of Transcutaneous Electrical Nerve Stimulation (TENS) and Exercise for Chronic Low Back Pain

Abstract

A number of treatments are widely prescribed for chronic back pain, but few have been rigorously evaluated. We examined the effectiveness of transcutaneous electrical nerve stimulation (TENS), a program of stretching exercises, or a combination of both for low back pain. Patients with chronic low back pain (median duration, 4.1 years) were randomly assigned to receive daily treatment with TENS (n = 36), sham TENS (n = 36), TENS plus a program of exercises (n = 37), or sham TENS plus exercises (n = 36). After one month no clinically or statistically significant treatment effect of TENS was found on any of 11 indicators of outcome measuring pain, function, and back flexion; there was no interactive effect of TENS with exercise. Overall improvement in pain indicators was 47 percent with TENS and 42 percent with sham TENS (P not significant). The 95 percent confidence intervals for group differences excluded a major clinical benefit of TENS for most outcomes. By contrast, after one month patients in the exercise groups had significant improvement in self-rated pain scores, reduction in the frequency of pain, and greater levels of activity as compared with patients in the groups that did not exercise. The mean reported improvement in pain scores was 52 percent in the exercise groups and 37 percent in the nonexercise groups (P = 0.02). Two months after the active intervention, however, most patients had discontinued the exercises, and the initial improvements were gone. We conclude that for patients with chronic low back pain, treatment with TENS is no more effective than treatment with a placebo, and TENS adds no apparent benefit to that of exercise alone.

Influência da estimulação elétrica nervosa transcutânea (TENS) associada ao alongamento muscular no ganho de flexibilidade

“…Although TENS is well known in clinical practice as an analgesic resource, some studies state that there is no scientific evidence to support the use of TENS for pain relief in certain conditions 26,27 . In the same way, the present research indicates that the application of TENS was not effective in reducing the perception of pain during hamstring muscle stretching.…”

New Therapy for Refractory Chronic Mechanical Low Back Pain—Restorative Neurostimulation to Activate the Lumbar Multifidus: One Year Results of a Prospective Multicenter Clinical Trial

“…However, the quality of evidence for the effectiveness of these pain management techniques in this patient population is poor 8, 9, 10, 11.…”

Ethnic Differences in Responses to Pain Management

“…This is a very important study for clinicians treating MPS of the head/neck area. Indeed, this report is reminiscent of one published in the New England Journal of Medicine in 1990, when the question pertained to the use of TENS for management of low back pain (8).…”