Effects of TDCS and TENS on chronic low back pain: A randomized controlled clinical trial.

BACKGROUND AND OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) and cryotherapy are physical therapy resources individually used, since there is the possibility of interaction between TENS and cryotherapy if they are associated. This study aimed at evaluating the analgesic effectiveness of the association or not of TENS and cryotherapy to relieve chronic low back pain. METHOD: Clinical trial involving six chronic low back pain patients distributed in three groups: cryotherapy, TENS, and the association of both techniques. Analgesia was induced for 20 minutes during 5 days, with one session per day. All patients were submitted to conventional kinesiotherapy with ischiotibial, lumbar square and iliopsoas elongation, aiming at increasing adherence to treatment. Cryotherapy was applied with crushed ice bag and TENS was in burst with Physiotonus TENS/FES 3050 equipment of the BIOSET brand, with pulse trains of 2 Hz, individual pulse frequencies of 100 Hz and pulse duration of 150 µs. Pain intensity was evaluated by the visual analog scale before and after each session. RESULTS: With regard to pain intensity in the cryotherapy group, initial and final medians were 5.5 and 4, respectively. For the TENS and TENS associated to cryotherapy groups they were 5 and 3, respectively. With regard to pain relief, 100% have referred good relief in the TENS group; in cryotherapy and TENS associated to cryotherapy groups 50% have referred good relief and 50% very good relief. CONCLUSION: Although the combined therapy has caused no significant improvement as compared to isolated therapies the three analgesic modalities used in this study were effective to relieve chronic low back pain. Satisfaction was higher in the cryotherapy group as compared to the TENS group.

Objective: To examine the effectiveness of rhythmic stabilization exercises and transcutaneous electrical nerve stimulation (TENS) and their combination in treating women with chronic low back pain. Design: Sequentially allocated, single-blinded and controlled study, with a two-month follow-up. Setting: The data were collected in a patient rehabilitation setting. Subjects: A total of 92 women (34—46 years old) with chronic low back pain were studied. Interventions: Sequential allocation was undertaken into four groups: `rhythmic stabilization' (n=23), `rhythmic stabilization — TENS' (n=23), TENS (n=23), and a placebo group (n = 23). Each programme lasted for four weeks. All outcome measures were assessed prior to, immediately after, four weeks and eight weeks post intervention. Main measures: Data were obtained on functional disability, pain intensity, trunk extension range of motion, dynamic endurance of trunk flexion and static endurance of trunk extension. Results: A total of 88 patients provided two-month follow-up data. The `rhythmic stabilization' and the `rhythmic stabilization — TENS' groups displayed statistically significant (P<0.05) improvements in functional disability and pain intensity (ranging from 21.2 to 42.8%), trunk extension range of motion (ranging from 6.5 to 25.5%), dynamic endurance of trunk flexion and static endurance of trunk extension (ranging from 13.5 to 74.3%) compared with the remaining groups. Conclusions: The rhythmic stabilization programmes resulted in more gains in women with chronic low back pain regarding the present outcome variables compared with the other groups; therefore, its application in female chronic low back pain patients aged 34—46 years is recommended.

Transcutaneous electrical nerve stimulation (TENS) is a promising non-pharmacological modality for the management of chronic low back pain (CLBP), but its efficacy and mode of action have not been clearly established. To evaluate the responses of plasma beta-endorphin (βE), met-enkephalin (ME), and pain intensity (PI) among patients with CLBP exposed to TENS or sham-TENS. This double-blind trial involved 62 participants (aged 53.29 ± 5.07 years) randomised into TENS group (frequency 100 Hz, burst-rate 2 Hz, burst-width 150 μs, intensity 40 mA, duration 30 min), and sham-TENS group. The PI and plasma concentrations of βE and ME were measured at baseline, immediately (0 hr), 1 hr, 24 hrs, and 48 hrs post-intervention. Data were analysed using general linear model repeated measures, ordinal regression, one-way analysis of variance, Kruskal-Wallis test, independent and paired samples t-tests, Mann-Whitney U test, Wilcoxon signed-rank test, and Kendall's tau coefficient. There was a significant temporal difference in PI between groups, F (1, 58) = 18.83, p< 0.001; the TENS group had better pain relief. The relative analgesic effect of TENS started immediately after the intervention (median difference [M⁢D] =-3, p< 0.001), peaked at 1 hr (M⁢D=-4, p< 0.001), and worn out by 24 hrs (M⁢D=-1, p= 0.029). However, there was no significant difference in βE and ME between the groups from 0 hr to 24 hrs post interventions, and no significant correlation between the PI, and βE, or ME. TENS significantly reduced PI up to 24 hrs after treatment.

The objectives of this study were the following: to determine if fatigue is present in chronic low back pain (LBP) and chronic neck pain patients to a greater extent than in controls (nonpatients); to determine which variables are associated with the presence of fatigue; and to determine which of the above chronic pain patient (CPP) groups is more fatigued. To the authors' knowledge, this is the first such study in the literature. Totals of 175 chronic LBP and 33 chronic neck pain patients completed the Multidimensional Fatigue Inventory (MFI), Neuropathic Pain Scale (NPS), and Beck Depression Inventory rating scales on admission. In addition, an information tool was completed on each CPP and contained the following information: demographics, primary and secondary pain diagnoses, DSM-IV psychiatric diagnoses assigned, pain location, pain precipitating event, type of injury, years in pain, number of surgeries, types of surgery, type of pain pattern, opioids consumed per day in morphine equivalents, workers' compensation status, and whether, according to the clinical examination, the pain did or did not have a neuropathic component. Scores on the MFI were then compared with published norms for controls (nonpatients) via chi-squared tests. Bivariate analyses were conducted between the MFI subscales and the variables selected for analysis. Pearson correlations, analyses of variance, and t-tests were used to test for relationships between MFI scale scores and the appropriate variables. In the next step of the analysis, stepwise regression analyses were used to predict each of the MFI subscale scores using the variables that were found to be significantly (P < 0.05) related to fatigue by the preceding analysis. In the final analysis, the variables that were significant predictors of the fatigue subscales were controlled for as covariates in an analysis of variance in order to determine if chronic LBP patients had scores on the MFI subscales that were significantly different from those of chronic neck pain patients. Multidisciplinary pain facility. Chronic LBP and chronic neck pain patients. Chronic LBP and chronic neck pain patients were found to be significantly more fatigued than controls (nonpatients). Most of the MFI subscale scores could be predicted by four major variables: presence of neuropathic pain, female gender, presence of depression, and total number of DSM-IV diagnoses. Chronic LBP patients were as fatigued as chronic neck pain patients. The complaint of fatigue appears to be a significant problem for chronic LBP and chronic neck pain patients. This complaint may be associated with neuropathic pain, female gender, and psychiatric comorbidities.

Pain and impairment beliefs in chronic low back pain: validation of the Pain and Impairment Relationship Scale (PAIRS)

Statistical data show that one in five adults of the European citizen suffer from some type of chronic pain. One of the most common types of chronic pain is chronic low back and neck pain. Emotional factors are currently viewed as important determinants in pain perception and behaviour. The perceived social and emotional support have impact to the individual’s adaptation to chronic disease (Cohen, Wills, 1985). The material: 110 chronic low back pain (CLBP) patients (48 male and 62 female; in age from 24 to 60 years, mean: 44.2±8, 0) and pilot study of 23 chronic neck pain (CNP) patients (19 female and 4 male; in age from 35 to 60 years, mean: 48, 1 ±6. The assessment methods: structured interview; Hospital Anxiety and Depression Scale (HADS). SF-36 ® Health Survey: assessment of emotional and social support. Results and conclusions: CLBP patients in presence of symptoms of depression and elevated level of anxiety matched for socio-demographic features had less sense of social support and marked pain impact to daily activities, lower self rating health relating quality of life. In CLBP patients the sense of social and emotional support had relevant interaction with level of participation in daily activities both in patients with and without mental health problems. This fact has to be considered in process of rehabilitation and in managing of health care of CLBP patients. The results of CNP patients pilot study revealed interesting trend that chronic back and neck pain patients seems to be quite different according to sense of social and emotional support, therefore sense of social and emotional support in different chronic pain patients need further research to improve the process and results of rehabilitation in these patients.

A pilot study on using acupuncture and transcutaneous electrical nerve stimulation to treat chronic non-specific low back pain

Randomized clinical trial comparing of transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) in knee osteoarthritis

Background &amp; objective: Low back pain is a common problem, especially in the young and middle-aged working people, and is often very resistant to the conventional management. We evaluated the impact of transcutaneous auricular vagus nerve stimulation (tVNS), applied in conjunction with an exercise treatment program, on disability in chronic low back pain patients.&#x0D; Methodology: The study was conducted from June to October 2022. Twenty-two patients aged 42.18 ± 9.91 y, with Numerical Pain Rating Scale (NPRS) score 5.64 ± 1.09 and Roland Morris Disability Questionnaire (RMDQ) score 10 ± 4.670, were randomly assigned to two groups. The control group received only exercise therapy (EXC group, n = 11), and the intervention group received exercise and tVNS therapy (EXC + tVNS group, n = 11). The primary outcome was RMDQ, measured before and after the intervention.&#x0D; Result: The mean RMDQ was significantly improved in both groups. In the intervention group the improvement was from 9.45 ± 4.44 to 2.18 ± 2.71 (P = 0.000), in the control group it was from 10.55 ± 5.05 to 2.36 ± 2.06 (P = 0.001). Inter-group comparison showed no significant difference. The effect size of the control group (2.12) was similar with the intervention group (1.98).&#x0D; Conclusion: Addition of 2-weeks tVNS to exercise therapy did not show superior effect on disability improvement compared to exercise only in chronic low back pain. Exercise alone was sufficient to improve the mean RMDQ.&#x0D; Abbreviations: CLBP: Chronic low back pain; EXC: Exercise; tVNS: Transcutaneous auricular vagus nerve stimulation; NPRS: Numerical pain rating scale; RMDQ: Roland Morris disability questionnaire&#x0D; Key words: Chronic low back pain; Disability; Exercise; Transcutaneous Auricular Vagus Nerve Stimulation&#x0D; Citation: Uzlifatin Y, Arfianti L, Wardhani IL, Hidayati HB, Melaniani S. Effect of transcutaneous auricular vagus nerve stimulation in addition to exercise on disability in chronic low back pain patients: a randomized controlled study. Anaesth. pain intensive care 2022;27(1):73−81; DOI: 10.35975/apic.v27i1.2084&#x0D; Received: December 07, 2022; Reviewed: December 28, 2022; Accepted: January 11, 2022

Transcutaneous electrical nerve stimulation: Nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain

Introduction: To study the effects of transcutaneous electrical nerve stimulation (TENS) on postural control in chronic low back pain (CLBP) patients. Materials and Methods: The current study is an experimental one with twenty eight patients suffering from chronic LBP (25-45 Y/O). At first non-random sampling technique was used to have the study subjects selected, using block randomization, then, we assigned them to main groups known as intervention and control. The mean center of pressure (COP) velocity and displacement were measured at three time intervals; prior to the intervention, once the intervention was provided and thirty minutes after it. The tests were done with eyes open and closed on a force platform. Sensory electrical stimulation was applied through the TENS device. Descriptive statistics, independent sample test, repeated measurement and ANOVA with repeated measurement on time were used for data analysis. Results: The results of the present study demonstrated that the application of sensory electrical stimulation among patients with CLBP could improve the postural control in Medio-lateral immediately after and 30 minutes following the application of TENS among the patients with their eyes closed ( P <0.05). Also, COP displacement and velocity in ML direction with eyes closed significantly decreased immediately and 30 min after application of sensory electrical stimulation in the intervention group in comparison with the control group ( P <0.05). Conclusion: Low frequency TENS with contraction level amplitude seems to have positive effects on postural control in patients suffering from CLBP. So, this study showed the effectiveness of low frequency TENS to imprive postural control in patients with CLBP. Key words: Chronic Low Back Pain, Postural Control, Transcutaneus Electrical Nerve Stimulation

BACKGROUND AND OBJECTIVES: Chronic low back pain has an incidence of 70% in general population and induces significant limitations. As treatment, physiotherapy stands out with a wide variety of techniques among them, for pain relief, electrotherapy is a useful tool. This study aimed at comparing the analgesic effects of transcutaneous electrical nerve stimulation and interferential current in patients with chronic low back pain. METHODS: Randomized clinical trial carried out between August 2013 and May 2014 in the clinic school of physiotherapy, Ulbra-Torres, with chronic low back pain patients. Patients were divided in two groups: intervention group (IG) treated with interferential current and control group (CG) treated with transcutaneous electrical nerve stimulation. Visual analog scale, Oswestry Questionnaire and Roland Morris Disability Questionnaire were used for baseline evaluation. Patients were treated for five weeks, twice a week, in a total of 10 interventions. At the end, they were re-evaluated and one month after they were submitted to follow-up with the visual analog scale. RESULTS: Participated in the study 28 patients, being 14 in IG and 14 in CG. Sample was homogeneous intragroups for gender, age, color and mean pain duration. There has been significant pain improvement in both groups by the visual analog scale and functionality improvement by Oswestry and Roland Morris Disability Questionnaires when comparing baseline and final evaluations (p<0.05). CONCLUSION: There were positive results in chronic low back pain improvement both with transcutaneous electrical nerve stimulation and interferential current, without significant difference between transcutaneous currents.

Background: Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is a relatively safe, non-invasive, and easy-to-use modality, making it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Short wave diathermy (SWD) is a modality that produces deep heating by converting electromagnetic energy to thermal energy. Short wave diathermy (SWD) is also a popular therapy for low back pain. Methods: This randomized controlled clinical trial was conducted to evaluate the comparative efficacy between TENS and SWD on chronic nonspecific low back pain patients. 120 patients with chronic low back pain were treated according to inclusion &amp; exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) were treated with NSAID+ADL, Group-B patients (n=40) were treated with NSAID+ADL+TENS, and Group-C patients (n=40) were treated with NSAID+ADL+SWD. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer-based software SPSS (Statistical Package for Social Science) Windows 16.0 version. Main outcome measure (s) Age, Sex, Occupational status, Socioeconomic status, Subjective pain intensity score, Visual Analogue Scale, Tenderness index, Disability due to pain, Spinal mobility index, and Oswestry disability Index. Results: The mean duration of pain was found to be 23.90±2.57 months in group A, 21.0+1.50 months in group B and 22.1±1.89 months in group C. The visual analog score was improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). Oswestry disability questionnaire score was also improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). In the case of comparison between group-B and Group C, this was not statistically significant (P&gt;0.05). In this current study, it was observed that the entire variable individually improved in Group-A, Group B, and Group C. So, all three treatment groups benefited from drugs and therapy. But, these were not statistically significant (P&gt;0.05) between Group B and Group C. Conclusion: Beneficial effects of TENS and SWD were seen in the study population, but no firm conclusion could be drawn. TAJ 2023; 36: No-2: 135-143

Background: Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is a relatively safe, non-invasive, and easy-to-use modality, making it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Short wave diathermy (SWD) is a modality that produces deep heating by converting electromagnetic energy to thermal energy. Short wave diathermy (SWD) is also a popular therapy for low back pain.&#x0D; Methods: This randomized controlled clinical trial was conducted to evaluate the comparative efficacy between TENS and SWD on chronic nonspecific low back pain patients. One hundred twenty patients with chronic low back pain were treated according to inclusion &amp; exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) were treated with NSAID+ADL, Group-B patients (n=40) were treated with NSAID+ADL+TENS, and Group-C patients (n=40) were treated with NSAID+ADL+SWD. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer-based software SPSS (Statistical Package for Social Science) Windows 16.0 version. Main outcome measure (s): Subjective pain intensity score, visual analogue scale, tenderness index, disability due to pain, spinal mobility index, and Oswestry disability index.&#x0D; Results: The mean duration of pain was found to be 23.90±2.57 months in group A, 21.0+1.50 months in group B and 22.1±1.89 months in group C. The visual analog score was improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). Oswestry disability questionnaire score was also improved individually in group-A, group B and Group C after treatment, which was statistically significant (P&lt;0.05). In the case of comparison between Group B and Group C, this was not statistically significant (P&gt;0.05). In this current study, it was observed that the entire variable individually improved in Group-A, Group B, and Group C. So, all three treatment groups benefited from drugs and therapy. However, these were not statistically significant (P&gt;0.05) between Group B and Group C.&#x0D; Conclusion: Beneficial effects of TENS and SWD were seen in the study population, but no firm conclusion could be drawn.&#x0D; TAJ 2022; 36: No-1: 63-73

BackgroundLow back pain (LBP) is one of the most common musculoskeletal disorders related to working. Due to the nature of nursing work, this problem is often seen in nurses, including those who work in the operating rooms. Depending on the cause, there are various surgical and non-surgical methods to treat LBP. The present study was aimed to compare the effect of two therapeutic methods of back exercises and transcutaneous electrical nerve stimulation (TENS) on the disability and pain of operating room nurses with LBP.MethodsIn this clinical trial forty-four eligible operating room nurses (30 women, 14 men, mean age: 37.86 ± 6.74) with chronic nonspecific LBP were randomly assigned to back exercises (including the strengthening and stretching exercise (n = 22)) or TENS (n = 22) groups by permuted block randomization method.These interventions were performed in both groups three sessions of 15 min per week for 6 weeks. The McGill pain questionnaire for back pain and the Oswestry disability questionnaire for disability assessment were completed immediately before and after the interventions.ResultsAfter 6 weeks, the mean of pain and disability decreased significantly in both groups compared to the baseline. Based on the results, significant decreases in the pain score (mean difference (95% CI): − 8.95 (− 12.77 to − 5.14); P-value < 0.001) and disability score (mean difference (95% CI): − 8.73(− 12.42 to − 5.03); P-value < 0.001) were revealed in the back exercises group after the intervention compared to the baseline. In addition, after the intervention in TENS group, the mean pain intensity and disability showed significant decrease, respectively (mean difference (95% CI): − 16.18 (− 19.81 to − 12.55); P-value < 0.001; mean difference (95% CI): − 15.82 (− 19.24 to − 12.40); P-value < 0.001).After adjusting for the baseline values, the TENS group had a significantly higher pain score reduction than the back exercises group (mean difference (95% CI): − 4.23 (− 8.03 to − 0.44); P-value =0.030; Cohen’s d = 0.81). In addition, TENS led to a significant more decrease in the disability scores compared to the back exercises (mean difference (95% CI): − 3.99 (− 7.35 to − 0.64); P-value =0.021; Cohen’s d = 0.73). Furthermore, a statistically significant time by group interaction effect on pain and disability score was found (interaction p < 0.001).ConclusionPain and disability were improved in both groups following 18 intervention sessions. However, pain and disability were improved to a greater extent in the TENS group than in the back exercises group.Trial registrationThe trial was retrospectively registered in the Iranian Registry of Clinical Trials (www.irct.ir) on 03/02/2019 as IRCT20180408039227N1.