High intensity-transcutaneous electrical nerve stimulation does not inhibit temporal summation of the nociceptive flexion reflex

Abstract

Pain facilitation contributes to chronic pain conditions. Transcutaneous electrical nerve stimulation (TENS) is used to alleviate pain. The effects of conventional TENS on chronic pain have been limited, and its effects on pain facilitation are controversial. Because the analgesic effects of TENS depend on the setting parameters (e.g., pulse intensities or treatment time), the optimal TENS settings to maximize analgesic effects under various pain conditions have been investigated. High-intensity TENS (HI-TENS), which involves tolerable-level pulse intensities for a short duration, is another conventional TENS method that used to alleviate pain. However, the effects of HI-TENS on pain facilitation remain unclear. The temporal summation of pain is widely used to evaluate pain facilitation, and the temporal summation-nociceptive flexion reflex (TS-NFR) is a neuropsychological parameter that can be used to evaluate pain facilitation. We aimed to investigate the effects of HI-TENS on the TS-NFR in healthy participants. Participants were randomly allocated into HI-TENS (n = 15) and control groups (n = 16). HI-TENS was administered at the left lateral lower leg for 1 min. The TS-NFR elicited by three noxious stimuluses at the left sural nerve was obtained from electromyography of the left biceps femoris. The nociceptive flexion reflex (NFR) was obtained by a single noxious stimulus. We measured the thresholds of the NFR and the TS-NFR at baseline and post-intervention. The application of HI-TENS significantly increased the NFR threshold (p = 0.013) but not the TS-NFR threshold (p > 0.05). These results suggest that HI-TENS does not inhibit pain facilitation.