The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury

Abstract

Study design: Prospective, randomized and controlled study. Objectives: The aim of the study was to investigate the effect of low-frequency transcutaneous electrical nerve stimulation (LF-TENS) in the treatment of neuropathic pain in patients with spinal cord injury (SCI). Methods: A total of 33 SCI patients with neuropathic pain were included in the study. History, duration, localization and characteristics of pain were recorded. Visual analog scale (VAS) was used to investigate the effect of LF-TENS four times during the day. Patients were randomly assigned to study and control groups. The study group was treated with 30 min of LF-TENS daily for 10 days while the placebo group with 30 min of sham TENS. Results: The mean age of the patients was 36.55 ± 10.36 years. Out of 33 patients, 7 were tetraplegic and 26 were paraplegic. Twenty-three patients had complete SCI while 10 patients had incomplete injuries. Two groups were similar with respect to age, gender, duration, level and severity of injury. In the LF-TENS treatment group, a statistically significant reduction of the VAS values was observed, however, such an effect was not evident in the control group. Conclusion: This study revealed that in treatment of neuropathic pain of SCI patients, LF-TENS may be effective. Perspective: This article presents LF-TENS may effectively complement pharmacological treatment in patients with SCI and neuropathic pain.

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment

“…Two prospective-controlled observational studies have been performed evaluating the effect of TENS in patients with SCI-related NP. 38,39 One trial found no significant difference between high-frequency and low-frequency TENS. 38 The second trial found a significant effect of low-frequency TENS on pain intensity reduction, and the quality of evidence was upgraded because the study included a control group and randomized the participants.…”

“…38,39 One trial found no significant difference between high-frequency and low-frequency TENS. 38 The second trial found a significant effect of low-frequency TENS on pain intensity reduction, and the quality of evidence was upgraded because the study included a control group and randomized the participants. 39 An early (1975) observational case series found a pain intensity reduction with TENS for two of 11 patients.…”

“…Few side effects are associated with TENS, but patients have reported increased pain intensity and muscle spasm. 38 The WG did not include TENS among the therapies without specific recommendations because of a lack of long-term follow-up, as the relatively innocuous side effects of TENS make this therapy more appropriate for a therapeutic trial in refractory cases.…”

“…Recent trials have used placement of electrodes at the level of injury in an area with preserved or intact sensibility. 38,39 Recommendation 2.9 Oxycodone can be used for the reduction of neuropathic pain intensity among people with SCI.…”

How well do randomised controlled trials of physical interventions for people with spinal cord injury adhere to the CONSORT guidelines? An analysis of trials published over a 10-year period

“…Table 2 and Figure 1 show the reporting of each CONSORT item. The median (IQR) number of CONSORT items per trial that was 'fully reported' was 11/37 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The median (IQR) number of CONSORT items per trial that was either 'fully reported' or 'not relevant' or 'not reported but unable to determine if relevant/done' was 20/37 items (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”