Does transcutaneous electrical nerve stimulation (TENS) have a clinically relevant analgesic effect on different pain conditions? A literature review

Abstract

Transcutaneous electric nerve stimulation (TENS) is a standard therapy used in different painful conditions such as low back pain, diabetic polyneuropathy or arthrosis. However, literature reviews focusing on the effects and the clinical implication of this method in various painful conditions are yet scarce. The purpose of this literature research was to determine, whether TENS provides an analgesic effect on common painful conditions in clinical practice. Literature research was performed using three data bases (Pubmed, Embase, Cochrane Database), focusing on papers published in the space of time from 2007 to 2012. Papers were evaluated from two reviewers independently concerning the clinical outcome, taking account for the level of external evidence according to the German Cochrane levels of evidence (Ia -IV). 133 papers of varying methodological quality dealing with different painful conditions were selected in total. A clinically relevant analgesic effect was described in 90 painful conditions (67%). In 30 painful states (22%), the outcome was inconclusive due to the study design. No significant analgesic effect of TENS was observed in 15 painful conditions (11%). The vast majority of the papers were classified as Cochrane evidence level Ib (n = 64; 48%), followed by level Ia (n = 23; 17%), level III (n = 18; 14%), level IV (n = 15; 11%), level IIb (n = 10; 8%) and level IIa (n = 3; 2%). Most of the studies revealed an analgesic effect in various painful conditions, confirming the usefulness of TENS in clinical practice.

Basic Understanding of Transcutaneous Electrical Nerve Stimulation

“…8) In addition, clinical experience have suggested that TENS was beneficial for acute and chronic pains with nociceptive, neuropathic or musculoskeletal origin. 6,11) Large meta-analyses also suggested the positive outcomes for the relief of musculoskeletal and post-operative pain. [70][71][72] Moreover, a number of basic scientific researches so far demonstrated the neurophysiological …”

“…It can be even selfadministered by the patients after a short instruction and individually titrated by themselves according to the analgesic response to the given electrical stimuli. 6) While previous meta-analyses and reviews supported positive outcomes for the relief of various musculoskeletal and post-operative pains, many systematic reviews regarded them to remain inconclusive. 4,[7][8][9][10] However, it was indicated that while some studies included in previous reviews were the randomized controlled clinical trials on TENS, but most studies had the methodological weakness like small sample sizes and possibility of underdosing stimuli.…”

“…4,[7][8][9][10] However, it was indicated that while some studies included in previous reviews were the randomized controlled clinical trials on TENS, but most studies had the methodological weakness like small sample sizes and possibility of underdosing stimuli. 6,11) A number of basic scientific studies proved that TENS could inhibit the central transmission of nociceptive impulses through the involvement of endogenous opioids, gamma-amino butyric acid (GABA), acetylcholine, 5-HT, noradrenaline and adenosine at peripheral, spinal or supraspinal (brainstem) sites levels. [12][13][14][15] Moreover, clinical experience suggests that TENS is still beneficial for various pains with neuropathic, nociceptive or musculoskeletal origin and popular with patients as well as clinician.…”

Interventions in pain management for persons with an intellectual disability

“…Within the general literature, it has been difficult to test TENS efficacy in patients with neuropathic pain because trials have a low fidelity associated with inadequate TENS technique and infrequent treatments of insufficient duration (Johnson and Bjordal, 2011). However, Naka et al (2013) in their systematic review highlight that most studies revealed an analgesic effect in various painful conditions, confirming the usefulness of TENS in clinical practice. Massage is asserted to be effective in inducing relaxation and reducing challenging behaviours in persons with intellectual disabilities (Chan and Tse, 2011).…”

An Investigation into the Effect of Transcutaneous Electrical Nerve Stimulation on Postoperative Pain Intensity in Patients with Bone Fracture: A Clinical Trial

“…There are numerous studies on pain relief through TENS, which have reached different results. Systematic review studies examining the impact of TENS on acute pain have not obtained identical results and, to date, there is no general consensus in this regard, such that a number of authors have supported TENS, but others have dismissed it (18)(19)(20)(21). In Iran, several studies have been done into the effect of TENS on acute pain control (postcesarean pain, pain during the insertion of peripheral venous catheter, burn dressing change, and subcutaneous injection pain) (22)(23)(24)(25)(26)(27)(28).…”