Neurology Central

Transcutaneous electrical nerve stimulation: current status of evidence

In the UK, NICE is in the processes of updating its guidance on the early management of nonspecific low back pain and sciatica. The draft recommendations were released for public consultation on 24 March 2016 and concluded that all forms of exercise including stretching, strengthening, aerobic or yoga should be used in the first instance in conjunction with encouraging people to continue normal activities of daily living [1]. Physical and psychological therapies were also recommended for people who did not improve with previous treatments. The draft guidance states “Do not offer TENS (transcutaneous electrical nerve stimulation) for managing nonspecific low back pain with or without sciatica”, based on a paucity of randomized controlled clinical trials (RCTs) on which to judge clinical efficacy. This not only raises a doubt about the clinical efficacy of TENS for nonspecific low back pain but also for the relief of pain for other conditions. Interestingly, in 2016 a systematic review of 13 studies (267 patients) evaluating TENS for chronic low back pain found that TENS provided a significant reduction in pain for 2–24 weeks [2]. The aim of this editorial is to analyze the current status of evidence for TENS for pain relief.
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TENS is a technique that involves the delivery of mild pulsed electrical currents across the intact surface of the skin to stimulate low threshold nerves to relieve pain. A variety of healthcare practitioners (e.g., physicians, nurses, midwives and physiotherapists) offer TENS as a standalone treatment or combined with medication for symptomatic relief of inflammatory, neuropathic and musculoskeletal pain. TENS is popular with patients and practitioners because it is inexpensive, available without prescription, easy to self-administer and safe, with limited potential for toxicity or overdose [3]. One should be vigilant to claims by manufacturers that advanced technology incorporated into device design enables specific interactions with physiological mechanisms because any relationship between specific characteristics of electrical stimulation and physiological mechanisms may not influence clinical outcomes to any meaningful effect. Psychosocial factors have a strong influence on pain response. Thus, prescriptive, overcomplicated TENS technique should be avoided. Long-term users of TENS report that administering currents to generate a strong nonpainful TENS sensation at the site of pain (conventional TENS) is beneficial.

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