A review of the treatment of chronic low back pain with acupuncture-like transcutaneous electrical nerve stimulation and transcutaneous electrical nerve stimulation

Abstract

A meta-analysis of published studies was carried out to evaluate the effectiveness of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) and transcutaneous electrical nerve stimulation (TENS) in controlling pain and improving function in patients with chronic low back pain. Studies in English were identified by searches of EMBASE, MEDLINE, CISCOM and AMED. Other studies were located by citation tracking, searching by hand bibliographies and conference reports, and direct contact with subject experts. Studies were included in the meta-analysis if they were randomized controlled trials comparing ALTENS or TENS with a credible placebo in patients with low back pain of more than 8 weeks duration. Two reviewers extracted data on reduction in pain, changes in range of movement and functional status as well as determining the power of the included studies. Sixty-eight studies were initially identified, of which six (two using ALTENS and four using TENS) involving a total of 288 patients with mixed low back pathologies met the inclusion criteria for meta-analysis. The odds ratio (OR) of improvement in pain was calculated: ALTENS/TENS vs placebo OR = 2.1 (95% Cl 1.3–3.4) ALTENS vs placebo OR = 7.2 (95% CI 2.6–20.1), TENS vs placebo OR = 1.5 (95% CI 0.9–2.6). OR for range of motion (ROM) on ALTENS vs placebo was 6.6 (95% CI 2.4–18.6). There were insufficient data to assess the effect of TENS alone on ROM, functional status and return to work. Similarly there were not enough data to assess ALTENS and functional status and return to work. There is limited statistical evidence that ALTENS and TENS reduce pain and improve function in patients with chronic low back pain, at least in the short term. This review and analysis is severely restricted by the lack of quality, randomized controlled trials. Even 25 years since the introduction of these treatments, powerful randomized controlled studies on the most appropriate use of TENS/ALTENS for the management of chronic low back pain have yet to be produced.