Additional effect of transcutaneous electrical nerve stimulation in a therapeutic exercise program for sedentary with chronic neck pain: A double‐blind randomized controlled trial

Abstract

Purpose To evaluate the additional effect of high frequency (HF) or low frequency (LF) transcutaneous electrical nerve stimulation (TENS) in a specific therapeutic exercise program for the treatment of patients with chronic neck pain. Methods A randomized controlled trial. Sixty participants of both sexes and with chronic neck pain were randomized into three groups: therapeutic exercise group + placebo TENS (n = 20), therapeutic exercise group + HF TENS (n = 20) and therapeutic exercise group + low TENS frequency (n = 20). The following assessment instruments were used: Numerical Pain Rating Scale, Neck Disability Index, Pain‐Related Catastrophizing Thoughts Scale and Tampa Scale for Kinesiophobia. Participants were evaluated before the interventions, after eight treatment sessions and 1 month after the end of treatment. Primary outcome was disability measured after the eight treatment sessions. Secondary outcomes were pain intensity, catastrophizing, and kinesiophobia after eight treatment sessions and pain intensity 4 weeks after the end of the treatment sessions. Results The three groups were similar at baseline for personal and clinical characteristics. Regarding the main study analyses, there were no significant (p > 0.05) or clinical (d < 0.80) differences between the groups for the main variable (disability), nor for the secondary variables (pain intensity, catastrophizing and kinesiophobia). Conclusion HF or LF TENS, compared to placebo TENS, does not provide additional clinical benefits to an exercise program for patients with chronic neck pain.

Effects of exercise/physical activity on fear of movement in people with spine-related pain: a systematic review

“…The 17 studies selected were published between the years 2011 to 2023. The 17 selected studies (Nassif et al, 2011 ; Miyamoto et al, 2013 , 2018 ; Da Luz Junior et al, 2014 ; Vincent et al, 2014 ; Cruz-Díaz et al, 2017 , 2018 ; Keane, 2017 ; Zadro et al, 2019 ; Galan-Martin et al, 2020 ; Tagliaferri et al, 2020 ; Akodu et al, 2021 ; Vicente-Campos et al, 2021 ; Martins de Sousa et al, 2022 ; Cana-Pino et al, 2023 ; Hernandez-Lucas et al, 2023 ; Ogunniran et al, 2023 ) involved 1,354 participants. Variation in chronic non-specific spine-related pain, exercise/physical activity and measures used to assess kinesiophobia contributed to the significant level of heterogeneity between the studies and reported effect estimates.…”

“…This was largely because of blinding, allocation sequence concealment and deviation from intended intervention. Five studies (Nassif et al, 2011 ; Miyamoto et al, 2013 , 2018 ; Zadro et al, 2019 ; Galan-Martin et al, 2020 ) were rated as having high risk of risk, ten (Vincent et al, 2014 ; Keane, 2017 ; Cruz-Díaz et al, 2018 ; Tagliaferri et al, 2020 ; Akodu et al, 2021 ; Vicente-Campos et al, 2021 ; Martins de Sousa et al, 2022 ; Cana-Pino et al, 2023 ; Hernandez-Lucas et al, 2023 ; Ogunniran et al, 2023 ) with some concerns of bias and two (Da Luz Junior et al, 2014 ; Cruz-Díaz et al, 2017 ) deemed low risk. Most studies adequately described the follow-up period, but attrition rate was poorly defined.…”

“…The GRADE ranking indicated low certainty that there is no effect on treating/preventing low back pain following the Back School intervention. Additionally, in a study (Martins de Sousa et al, 2022 ) evaluating the effect of high frequency (HF) or low frequency (LF) transcutaneous electrical nerve stimulation (TENS) in a specific therapeutic exercise program for the treatment of patients with chronic neck pain; were rated as low. Fear of movement/Kinesiophobia - measured by TSK.…”

“…Some studies (Miyamoto et al, 2013 ; Zadro et al, 2019 ; Galan-Martin et al, 2020 ; Tagliaferri et al, 2020 ; Cana-Pino et al, 2023 ; Hernandez-Lucas et al, 2023 ) combined their interventions with aerobic exercise, supervised exercise and education such as pain neuroscience education. Other studies (Martins de Sousa et al, 2022 ; Ogunniran et al, 2023 ) used a combination of High- and low-frequency transcutaneous electrical nerve stimulation and exercise and kinesiology taping and core stabilization exercise. The control groups among the studies (Nassif et al, 2011 ; Miyamoto et al, 2013 , 2018 ; Vincent et al, 2014 ; Cruz-Díaz et al, 2017 , 2018 ; Keane, 2017 ; Zadro et al, 2019 ; Galan-Martin et al, 2020 ; Akodu et al, 2021 ; Vicente-Campos et al, 2021 ; Cana-Pino et al, 2023 ) either had no intervention, had usual physiotherapy treatment, or a form of education.…”

“…The control groups among the studies (Nassif et al, 2011 ; Miyamoto et al, 2013 , 2018 ; Vincent et al, 2014 ; Cruz-Díaz et al, 2017 , 2018 ; Keane, 2017 ; Zadro et al, 2019 ; Galan-Martin et al, 2020 ; Akodu et al, 2021 ; Vicente-Campos et al, 2021 ; Cana-Pino et al, 2023 ) either had no intervention, had usual physiotherapy treatment, or a form of education. From all the studies in the review, 14 (Nassif et al, 2011 ; Miyamoto et al, 2013 , 2018 ; Vincent et al, 2014 ; Cruz-Díaz et al, 2017 , 2018 ; Keane, 2017 ; Zadro et al, 2019 ; Galan-Martin et al, 2020 ; Akodu et al, 2021 ; Vicente-Campos et al, 2021 ; Martins de Sousa et al, 2022 ; Hernandez-Lucas et al, 2023 ; Ogunniran et al, 2023 ) had a control group, and ten studies (Da Luz Junior et al, 2014 ; Vincent et al, 2014 ; Cruz-Díaz et al, 2017 ; Keane, 2017 ; Miyamoto et al, 2018 ; Tagliaferri et al, 2020 ; Akodu et al, 2021 ; Martins de Sousa et al, 2022 ; Cana-Pino et al, 2023 ; Ogunniran et al, 2023 ) compared two or more interventions.…”