Transcutaneous Electrical Nerve Stimulation In Patients Research Articles

Risk of occurrence of electromagnetic interference from the application of transcutaneous electrical nerve stimulation on the sensing function of implantable defibrillators.

Transcutaneous electrical nerve stimulation (TENS) is an established method for pain relief. But electrical TENS currents are also a source of electromagnetic interference (EMI). Thus, TENS is considered to be contraindicated in implantable cardioverter-defibrillator (ICD) patients. However, data might be outdated due to considerable advances in ICD and cardiac resynchronization therapy (CRT) filtering and noise protection algorithm technologies. The aim of this pilot safety study was to re-evaluate the safety of TENS in patients with modern ICDs. One hundred and seven patients equipped with 55 different models of ICD/CRT with defibrillators from 4 manufacturers underwent a standardized test protocol including TENS at the cervical spine and the thorax, at 2 stimulation modes-high-frequency TENS (80 Hz) and burst-mode TENS (2 Hz). Potential interference monitoring included continuous documentation of ECG Lead II, intracardiac electrograms and the marker channel. Electromagnetic interference was detected in 17 of 107 patients (15.9%). Most frequent were: interpretations as a premature ventricular beats (VS/S) in 15 patients (14%), noise reversion in 5 (4.6%) which resulted in temporary asynchronous pacing in 3 (2.8%), interpretation as ventricular tachycardia/ventricular fibrillation in 2 (1.9%), and premature atrial beat in 2 (1.9%) patients. Electromagnetic interference occurrence was influenced by position (chest, P < 0.01), higher current intensity (P < 0.01), and manufacturer (P = 0.012). Overall, only intermittent and minor EMI were detected. Prior to the use of TENS in patients with ICDs, they should undergo testing under the supervision of a cardiac device specialist.

A Phase II, Randomized, Double-blind, Sham-Controlled Clinical Trial of Transcutaneous Electrical Nerve Stimulation (TENS) Therapy for the Treatment of Neuropathic Pain in Neuromyelitis Optica Spectrum Disorders (P13-5.005)

<h3>Objective:</h3> To determine whether Transcutaneous Electrical Nerve Stimulation (TENS) therapy is a safe, tolerable, and effective therapy for neuropathic pain in patients with Aquaporin-4 (AQP4) IgG positive Neuromyelitis Optica Spectrum Disorders (NMOSD). <h3>Background:</h3> NMOSD is a chronic relapsing neuroinflammatory disorder that preferentially targets the optic nerves and spinal cord. Pain due to the longitudinally extensive spinal cord lesions seen in NMOSD is a frequent, disabling, and difficult to treat component of the disease with up to 91% of patients reporting symptoms of central neuropathic pain. TENS therapy is a non-invasive pain-modifying intervention that utilizes transcutaneous electrical stimulation of ascending sensory fibers that has been investigated for the amelioration of peripheral neuropathic pain in several other conditions. <h3>Design/Methods:</h3> We conducted a 4-week, randomized, double-blind, sham-controlled, fully remote trial of the QUELL TENS in patients with NMOSD who have central neuropathic pain, followed by a 12-week open label extension period. The Numeric Rating Scale for Pain (NRS-P) was used as the primary outcome measure and was assessed at baseline and at weeks 1, 2, 3, 4, 5, 6, 7, 8, 12, and 16. <h3>Results:</h3> Forty-six patients (23 per arm) were enrolled in this trial, of which 37 completed the trial (3 in the intervention arm and 1 in the sham arm withdrew for adverse events possibly related to the device). Both the sham and intervention arms demonstrated a significant decrease in average pain, worst pain, and current pain between the baseline and 4 week periods, however there was no significant difference between the two arms on intention-to-treat primary or secondary efficacy outcomes. <h3>Conclusions:</h3> Both arms demonstrated significant decreases in reported pain between baseline and 4-week follow-up, however there was no demonstrated benefit of TENS over sham. Further trial analysis will be conducted analyzing responder groups, adverse events, and per-protocol results based on device usage data. <b>Disclosure:</b> The institution of Dr. Vishnevetsky has received research support from National MS Society. The institution of Dr. Vishnevetsky has received research support from NIH (NeuroNext). Ms. Romanow has received research support from Freeman Pain Award @ Harvard Medical School. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.

Transcutaneous electrical nerve stimulation reduces acute pain, and the use of analgesics after ankle fracture surgery

Objective: To evaluate the applicability of transcutaneous electrical nerve stimulation (TENS) as a complementary treatment method to non-opioid analgesics for acute postoperative pain in patients undergoing surgical treatment due to ankle fractures. Methods: A prospective, randomized, analytical, cross-sectional study performed after ankle fracture surgery. Two groups were randomized as follows: group 1 (Intervention) received TENS and non-opioid analgesic (dipyrone), and group 2 (Control) received non-opioid analgesic (dipyrone). Results: This study demonstrated that TENS in patients undergoing surgical treatment of ankle fractures reduces the use of rescue opioids significantly to control postoperative pain. Conclusion: TENS devices may be another safe option to control postoperative pain and reduce the use of opioids, avoiding adverse effects from this class of analgesic. Level of Evidence II; Therapeutic Studies; Prospective Comparative Study.

Effects of Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Non-specific Low Back Pain as an Add-on Therapy

Background : Transcutaneous Electrical Nerve Stimulation (TENS) is often used to treat Low-Back Pain (LBP). However, its effectiveness is controversial in non-specific chronic LBP (CLBP). The study aimed to determine TENS’ efficacy in treating non-specific CLBP when added to Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) and Activities of Daily Living (ADL). Materials and methods: This randomized controlled clinical trial was conducted in the Department of Physical Medicine and Rehabilitation of Chittagong Medical College Hospital, Chattogram, over six months from January 2019 to June 2019. Ninety patients suffering from LBP for more than six weeks were enrolled and randomized into Group A, and Group B. Patients in both groups were treated with NSAID+ADL. TENS was added to the patients of Group B. Subjective pain intensity score, Visual Analogue Scale (VAS) Tenderness index, Disability due to pain, Spinal mobility index and Oswestry Disability Index was the outcome parameters assessed at baseline and after eight weeks of intervention. Results: Ten patients were lost to follow-up (Five from each group) giving an effective sample of 80 (40 in each group). Both the groups were similar at enrollment in terms of the demographic, clinical and laboratory parameters. In Group A and B, the VAS score at baseline was 7.06±0.81 and 7.11±0.83, respectively. At eight weeks, the VAS score was 6.55±0.77 and 6.11±0.75, respectively, in Group A and B. Reduction of VAS scores was significant in both groups without any statistical differences. Similarly, Disability due to pain and Oswestry Disability Index scores reduced significantly from baseline to eight weeks after treatment in both groups, without statistically significant differences. Conclusion: The study ascertained no additional benefit of TENS in patients of non specific CLBP when added to NSAID and ADL. IAHS Medical Journal Vol 5(1), June 2022; 82-86

Comparison of the Efficiency of High-Intensity Laser Therapy and Transcutaneous Electrical Nerve Stimulation Therapy in Patients With Symptomatic Temporomandibular Joint Disc Displacement With Reduction

Many different treatment modalities have been tried in the treatment of temporomandibular joint (TMJ) disorders and different results have been reported. The aim of the study was to investigate and compare the effects of high-intensity laser therapy (HILT) and transcutaneous electrical nerve stimulation (TENS) therapy on the treatment of patients with TMJ disc displacement with reduction(DDWR). Researchers conducted a prospective, single-blind, controlled clinical trial on patients with TMJ disc disease at a university's oral and maxillofacial surgery clinic. One hundred two patients were randomized into 3 groups (HILT, TENS and control group). The patients were evaluated in terms of maximum mouth opening (MMO), assisted MMO, Visual Analog Scale (VAS) (pain), and VAS (function). In addition, the disability status of the patients with the Jaw Functional Limitation Scale-20 (JFLS-20) and the quality-of-life with the Oral Health Impact Profile (OHIP-14) was evaluated. At the start of the trial, in terms of socio-demographic characteristics, no significant differences existed between the groups. Significant improvements were seen in pain (VAS), MMO, total JFLS-20 and total OHIP-14 scores in the HILT and TENS groups compared to the control group. At week 4, the VAS pain score decreased significantly in the HILT group compared to the TENS group (48 and 25%, respectively), while the MMO was significantly increased (24 and 10%, respectively). In addition, there was a significant improvement in both the total JFLS-20 score and the total OHIP-14 score at weeks 4 and 12 in the HILT group compared to the TENS group (P < .05). It was observed that the healing effect of pulsed Nd: YAG laser therapy was significantly higher than TENS in patients with DDWR. Therefore, HILT should be a priority option over TENS therapy in patients with disc displacement.

Efficacy of TENS in Cervical Pain Syndromes: An Umbrella Review of Systematic Reviews

Neck pain is defined as perceived pain, originating in an area bounded above by the nuchal line, below by an imaginary line passing through the spinous process of T1 and laterally by the sagittal plane tangent to the lateral edges of the neck. Our purpose is to investigate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in patients suffering from both acute and chronic cervical pain syndromes. The literature research was conducted by consulting the following databases: PubMed, PEDro, Cochrane, and Google Scholar. To formulate the scientific question correctly, the PICO model was used. This umbrella review includes all systematic reviews with or without meta-analysis, in English, which analyze the use of TENS in subjects suffering from acute or chronic cervical pain. To evaluate the methodological quality of the studies, the AMSTAR model. A total of eleven systematic reviews with or without meta-analyses were included. The results of the study show how TENS seems to have an effect in reducing the intensity of acute and chronic cervical pain, especially in the short term. However, it was not possible to provide precise recommendations in this regard. Based on our result, it is desirable to carry out further studies that support the effectiveness of using TENS in patients suffering from acute and chronic neck pain.

Transcutaneous Electrical Nerve Stimulation in Relieving Neuropathic Pain: Basic Mechanisms and Clinical Applications.

Transcutaneous electrical nerve stimulation (TENS) is widely used as a non-pharmacological approach for pain relief in a variety of clinical conditions. This manuscript aimed to review the basic mechanisms and clinical applications regarding the use of TENS for alleviating the peripheral (PNP) and central neuropathic pain (CNP). Basic studies on animal models showed that TENS could alleviate pain by modulating neurotransmitters and receptors in the stimulation site and its upper levels, including the spinal cord, brainstem, and brain. Besides, many clinical studies have investigated the efficacy of TENS in patients with CNP (caused by spinal cord injury, stroke, or multiple sclerosis) and PNP (induced by diabetes, cancer, or herpes zoster). Most clinical trials have demonstrated the efficacy of TENS in attenuating neuropathic pain and suggested that appropriate stimulation parameters (e.g., stimulation frequency and intensity) were critical to improving the analgesic effects of TENS. However, there are some conflicting findings related to the efficacy of TENS in relieving neuropathic pain. With optimized stimulation parameters, TENS would be effective in attenuating neuropathic pain. To obtain sufficient evidence to support the use of TENS in the clinic, researchers recommended performing multicenter clinical trials with optimized TENS protocols for the treatment of various CNP and PNP.

Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain.

Chronic neck pain is a highly prevalent condition, affecting 10% to 24% of the general population. Transcutaneous electrical nerve stimulation (TENS) is the noninvasive, transcutaneous use of electrical stimulation to produce analgesia. It is a simple, low-cost and safe intervention used in clinical practice as an adjunct treatment for painful musculoskeletal conditions that have a considerable impact on daily activities, such as chronic neck pain. This review is a split from a Cochrane Review on electrotherapy for neck pain, published in 2013, and focuses specifically on TENS for chronic neck pain. To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) (alone or in association with other interventions) compared with sham and other clinical interventions for the treatment of chronic neck pain. We searched Cochrane Back and Neck Trials Register, CENTRAL, MEDLINE, Embase, five other databases and two trials registers to 9 November 2018. We also screened the reference lists of relevant studies to identify additional trials. There were no language, source, or publication date restrictions. We included randomised controlled trials (RCTs) involving adults (≥ 18 years of age) with chronic neck pain (lasting > 12 weeks) that compared TENS alone or in combination with other treatments versus active or inactive treatments. The primary outcomes were pain, disability and adverse events. Two independent review authors selected the trials, extracted data and assessed the risk of bias of included studies. A third review author was consulted in case of disagreements. We used the Cochrane 'Risk of bias' tool (adapted by Cochrane Back and Neck), to assess the risk of bias of individual trials and GRADE to assess the certainty of evidence. We used risk ratios (RRs) to measure treatment effects for dichotomous outcomes, and mean differences (MDs) for continuous outcomes, with their respective 95% confidence intervals (CIs). We included seven RCTs with a total of 651 participants, mean age 31.7 to 55.5 years, conducted in three different countries (Turkey, Jordan and China). The length of follow-up ranged from one week to six months. Most RCTs used continuous TENS, with a frequency of 60 Hz to 100 Hz, pulse width of 40 μs to 250 μs and tolerable intensity, described as a tingling sensation without contraction, in daily sessions lasting 20 to 60 minutes. Due to heterogeneity in interventions and outcomes, we did not pool individual study data into meta-analyses. Overall, we judged most studies as being at low risk for selection bias and high risk for performance and detection bias. Based on the GRADE approach, there was very low-certainty evidence from two trials about the effects of conventional TENS when compared to sham TENS at short-term (up to 3 months after treatment) follow-up, on pain (assessed by the Visual Analogue Scale (VAS)) (MD -0.10, 95% CI -0.97 to 0.77) and the percentage of participants presenting improvement of pain (RR 1.57, 95% CI 0.84 to 2.92). None of the included studies reported on disability or adverse events. This review found very low-certainty evidence of a difference between TENS compared to sham TENS on reducing neck pain; therefore, we are unsure about the effect estimate. At present, there is insufficient evidence regarding the use of TENS in patients with chronic neck pain. Additional well-designed, -conducted and -reported RCTs are needed to reach robust conclusions.

Efficacy and Safety of a Stimulator Using Low-Intensity Pulsed Ultrasound Combined with Transcutaneous Electrical Nerve Stimulation in Patients with Painful Knee Osteoarthritis.

Objective Studies regarding the combination of ultrasound and transcutaneous electrical nerve stimulation (TENS) are rarely reported. In this study, we aimed to elucidate the efficacy and safety of a stimulator using low-intensity pulsed ultrasound (LIPUS) combined with TENS in patients with painful knee osteoarthritis (OA). We evaluated the effectiveness of this therapy against pain, physical function, and cartilage regeneration. Moreover, we aim to prove the superiority of the effects of LIPUS combined with TENS therapy compared with only TENS therapy. Methods Of the 40 included patients, aged 45–85 years with painful knee OA, 20 patients received only TENS therapy and 20 patients received LIPUS combined with TENS therapy for 8 weeks (a total of more than 80 treatment sessions). We evaluated visual analogue scale (VAS), Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, MOS 36-Item Short-Form Health Survey (SF-36), and femoral articular cartilage (FAC) thickness. The evaluation was performed at three visits: visit 1 (V1, pretreatment, within 28 days after screening), visit 2 (V2, posttreatment period 1, ±3 days after treatment), and visit 3 (V3, posttreatment period 2, 21 ± 3 days after treatment). Results We expected that LIPUS combined with TENS therapy would be superior to only TENS therapy. However, there was no significant difference between the two therapies. In the within-group comparison, both treatments (only TENS therapy and LIPUS with TENS therapy) demonstrated statistical differences from baseline values for pain and physical function outcomes. FAC thickness showed no significant differences after treatment in both groups. Conclusion The effects of a stimulator using LIPUS with TENS on pain relief and functional improvement were not superior to the only TENS therapy. Cartilage regeneration, which was expected as an additional benefit of LIPUS, was also not significantly evident. Therefore, further investigation is warranted to determine whether the combination therapy is beneficial. This trial is registered with KCT0003883.

Influence of Transcutaneous Electrical Nerve Stimulation on Clinical Measures and Functional Capacity in Patients with Peripheral Artery Disease

Peripheral Arterial Disease (PAD), which is characterized by occlusive plaques in the arteries perfusing the legs, often manifests in intermittent claudication. Home‐based exercise is commonly suggested for individuals with PAD, but adherence to such programs is often poor, resulting in limited clinical benefits. Therefore, this patient population would benefit from low‐risk, inexpensive, and simple to use therapeutic interventions that can improve exercise tolerance and capacity. One such potentially beneficial intervention is transcutaneous electrical nerve stimulation (TENS), which may induce transient increases in leg blood flow sufficient to improve the matching of oxygen supply and demand distal to the site of stenosis in patients with peripheral artery disease (PAD). Thus, the purpose of this study was to test the hypothesis that a single bout of TENS applied to the lower leg (for 15 or 45 minutes) will increase resting popliteal artery blood flow and 6‐minute walk distance (6MWD) in patients with PAD. Five subjects with PAD (67–81 yrs.; Intermittent Claudication, Fontaine stage II) participated in the protocol. Four subjects attended the laboratory for three randomized visits during which bilateral lower leg TENS (burst mode; 3Hz burst rate; 100Hz freq.; 250 μs pulse duration) sufficient to evoke skeletal muscle contraction was carried out for either 15 or 45 minutes or subjects participated in a control visit. One subject completed only the control and 15 minute TENS trials. Clinical and cardiovascular measures including resting single leg popliteal artery blood flow (Doppler ultrasound), ankle‐brachial index (ABI), and toe oxygen saturation (pulse oximetry) were carried out prior to and beginning 10 minutes following TENS. Popliteal vascular conductance (PVC) was calculated as flow/mean arterial pressure. 6MWD and time/distance to claudication onset were measured on the control day and each experimental day 35 minutes post‐TENS. The 15‐minute TENS trial increased popliteal artery blood flow from 63.5 ± 10.9 to 89.8 ± 21.8 mL min−1 (42.2%; P &lt; 0.05; n=5), PVC from 0.70 ± 0.12 to 0.92 ± 0.21 mL min−1 mmHg−1 (31.5%; P &lt; 0.05; n=5), and 6MWD from 1018.0 ± 133.8 to 1141.6 ± 149.2 feet (12.1%; P &lt; 0.05; n=5). The 45‐minute TENS trial increased popliteal artery blood flow from 56.4 ± 9.3 to 74.4 ± 15.9 mL min−1 (32.1%; P = 0.056; n=4), PVC from 0.66 ± 0.15 to 0.81 ± 0.20 mL min−1 mmHg−1 (23.2%; P &lt; 0.05; n=4), and 6MWD from 943.8 ± 128.5 to 1096.3 ± 146.9 feet (14.9%; P &lt; 0.05; n=4). Furthermore, the subjects reported onset of claudication at 573.8 ± 84.4 feet of the control visit 6MW, which was compared to 810.0 ± 199.2 feet after the 15 minute TENS trial and 690.0 ± 60.1 feet after the 45 minute TENS trial (both P &gt; 0.05). Neither of the TENS trials evoked changes in ABI or toe oxygen saturation. These preliminary findings suggest that acute lower leg TENS in patients with PAD may increase leg perfusion and exercise tolerance which, if undertaken routinely, could increase either patient adherence to or efficacy of exercise prescription in this population.Support or Funding InformationSupported by the Salisbury University Faculty Mini‐Grant

Transcutaneous electrical nerve stimulation (TENS) for chronic neck pain

Background Chronic neck pain is a highly prevalent condition, affecting 10% to 24% of the general population. Transcutaneous electrical nerve stimulation (TENS) is the noninvasive, transcutaneous use of electrical stimulation to produce analgesia. It is a simple, low-cost and safe intervention used in clinical practice as an adjunct treatment for painful musculoskeletal conditions that have a considerable impact on daily activities, such as chronic neck pain. This review is a split from a Cochrane Review on electrotherapy for neck pain, published in 2013, and focuses specifically on TENS for chronic neck pain. Objectives To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) (alone or in association with other interventions) compared with sham and other clinical interventions for the treatment of chronic neck pain. Search methods We searched Cochrane Back and Neck Trials Register, CENTRAL, MEDLINE, Embase, five other databases and two trials registers to 9 November 2018. We also screened the reference lists of relevant studies to identify additional trials. There were no language, source, or publication date restrictions. Selection criteria We included randomised controlled trials (RCTs) involving adults (≥ 18 years of age) with chronic neck pain (lasting > 12 weeks) that compared TENS alone or in combination with other treatments versus active or inactive treatments. The primary outcomes were pain, disability and adverse events. Data collection and analysis Two independent review authors selected the trials, extracted data and assessed the risk of bias of included studies. A third review author was consulted in case of disagreements. We used the Cochrane 'Risk of bias' tool (adapted by Cochrane Back and Neck), to assess the risk of bias of individual trials and GRADE to assess the certainty of evidence. We used risk ratios (RRs) to measure treatment effects for dichotomous outcomes, and mean differences (MDs) for continuous outcomes, with their respective 95% confidence intervals (CIs). Main results We included seven RCTs with a total of 651 participants, mean age 31.7 to 55.5 years, conducted in three different countries (Turkey, Jordan and China). The length of follow-up ranged from one week to six months. Most RCTs used continuous TENS, with a frequency of 60 Hz to 100 Hz, pulse width of 40 μs to 250 μs and tolerable intensity, described as a tingling sensation without contraction, in daily sessions lasting 20 to 60 minutes. Due to heterogeneity in interventions and outcomes, we did not pool individual study data into meta-analyses. Overall, we judged most studies as being at low risk for selection bias and high risk for performance and detection bias. Based on the GRADE approach, there was very low-certainty evidence from two trials about the effects of conventional TENS when compared to sham TENS at short-term (up to 3 months after treatment) follow-up, on pain (assessed by the Visual Analogue Scale (VAS)) (MD -0.10, 95% CI -0.97 to 0.77) and the percentage of participants presenting improvement of pain (RR 1.57, 95% CI 0.84 to 2.92). None of the included studies reported on disability or adverse events. Authors' conclusions This review found very low-certainty evidence of a difference between TENS compared to sham TENS on reducing neck pain; therefore, we are unsure about the effect estimate. At present, there is insufficient evidence regarding the use of TENS in patients with chronic neck pain. Additional well-designed, -conducted and -reported RCTs are needed to reach robust conclusions.

Effect of progressive muscular relaxation exercises versus transcutaneous electrical nerve stimulation on tension headache: A comparative study

Abstract Tension-type headache (TTH) is most frequent among all types of headaches. According to the International Headache Classification Subcommittee of the International Headache Society (2004), TTH occurs in 30–78% of the population. Progressive muscular relaxation exercises have been shown to reduce TTH, and home-based relaxation programmes can result in significant improvement in headaches. Transcutaneous electrical nerve stimulation (TENS) is a method of electrical stimulation that primarily aims to provide a degree of symptomatic pain relief by exciting sensory nerves and stimulating either the pain gate mechanisms or the opioid systems. The objective of this study was to compare between the effects of progressive muscular relaxation exercises and TENS on pain intensity and stress in people with TTH. Thirty patients with TTH were allocated to either Group A or Group B. Group A practised progressive muscular relaxation exercise, whereas Group B received TENS. In the latter group, TENS electrodes were placed bilaterally either on the head at the site of pain or on the occiput. The treatment was carried out for 15 minutes a day, for 7 days. Patients were assessed for pain intensity (Visual Analogue Scale) and level of stress (Lakaev Academic Stress Response Scale) before and after the intervention period. The results showed that progressive muscular relaxation exercises were effective in reducing pain as well as stress ( p p p = 0.233). Between-group analysis revealed that there was no statistically significant difference in reduction of pain between the two groups ( p = 0.595), but the amount of stress reduction in Group A ( p = 0.002) was significantly more than that in Group B. In conclusion, progressive muscular relaxation exercises were more effective in reducing stress level than TENS in patients with TTH. The effect on pain reduction was similar between the two treatment methods.

Less deep vein thrombosis due to transcutaneous fibular nerve stimulation in total knee arthroplasty: a randomized controlled trial.

It has been known for years that deep vein thrombi (DVT) start to develop during total joint arthroplasty. Previously, we reported effective prevention of venous stasis by transcutaneous electrical nerve stimulation (TENS). It is hypothesized that TENS might be a thromboprophylactic tool for the limb undergoing surgery. The purpose of this study is to clarify the clinical efficacy and safety of TENS in patients during total knee arthroplasty (TKA). Ninety patients undergoing primary TKA were involved and randomly allocated to the TENS or control group. In the TENS group, electrical stimulation of the common fibular nerve, which produced a brisk dorsiflexion of the ankle, was performed for the operated leg during surgery. In the control group, no electrical stimulation was applied. Serum D-dimer and soluble fibrin monomer complex (SFMC) levels were measured before surgery, immediately after surgery, and post-operative day (POD) 1. Ultrasonography was performed on POD 1. Immediately after surgery, D-dimer and SFMC levels of each group were significantly lower in the TENS group compared with control (p < 0.05). The incidence of DVT was 11 % (five cases) in the TENS group while 31 % (14 cases) in control (p = 0.02). There were no adverse effects related to TENS. TENS during TKA showed significant effects on preventing DVT. Sustaining muscle pump activation during surgery prevented not only venous stasis, but also hypercoagulability of blood. Intraoperative TENS is a safe and novel strategy against early post-operative thromboembolism, which is difficult to be completed through existing prophylaxis after total joint arthroplasty. Randomized controlled trial, Level I.

Clinical and Economic Impact of TENS in Patients With Chronic Low Back Pain: Analysis of a Nationwide Database

This study evaluated patients who were given transcutaneous electrical nerve stimulation (TENS) compared with a matched group without TENS prior to intervention and at 1-year follow-up. Patients who were treated with TENS had significantly fewer hospital and clinic visits, used less diagnostic imaging (31 vs 46 events per 100 patients), had fewer physical therapy visits (94 vs 107), and required less back surgery (7.5 vs 9.2 surgeries) than patients receiving other treatment modalities. Total annual costs for chronic low back pain patients without neurological involvement were lower in TENS patients ($17,957 vs $17,986 for non-TENS), even when the cost of the device was taken into account.

Primary care randomized clinical trial: Manual therapy effectiveness in comparison with TENS in patients with neck pain

This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure finished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant “short term” result after having ended the intervention, when either MT or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.

Feasibility Study of Transcutaneous Electrical Nerve Stimulation (TENS) for Cancer Bone Pain

This multicenter study assessed the feasibility of conducting a phase III trial of transcutaneous electrical nerve stimulation (TENS) in patients with cancer bone pain recruited from palliative care services. Eligible patients received active and placebo TENS for 1 hour at site of pain in a randomized crossover design; median interval between applications 3 days. Responses assessed at 30 and 60 minutes included numerical and verbal ratings of pain at rest and on movement, and pain relief. Recruitment, tolerability, adverse events, and effectiveness of blinding were also evaluated. Twenty-four patients were randomised and 19 completed both applications. The intervention was well tolerated. Five patients withdrew: 3 due to deteriorating performance status, and 2 due to increased pain (1 each following active and placebo TENS). Confidence interval estimation around the differences in outcomes between active and placebo TENS suggests that TENS has the potential to decrease pain on movement more than pain on rest. Nine patients did not consider that a placebo was used; the remaining 10 correctly identified placebo TENS. Feasibility studies are important in palliative care prior to undertaking clinical trials. Our findings suggest that further work is required on recruitment strategies and refining the control arm before evaluating TENS in cancer bone pain. Cancer bone pain is common and severe, and partly mediated by hyperexcitability. Animal studies suggest that Transcutaneous Electrical Nerve Stimulation can reduce hyperalgesia. This study examined the feasibility of evaluating TENS in patients with cancer bone pain in order to optimize methods before a phase III trial.

Risk of Interference from Transcutaneous Electrical Nerve Stimulation on the Sensing Function of Implantable Defibrillators

The use of transcutaneous electrical nerve stimulation (TENS) for pain relief is increasing. At the same time the implantable cardioverter defibrillator (ICD) is a routine treatment for malignant tachyarrhythmias. Today patients often need devices for more than one condition, and consideration must be given to the interaction between them. We studied the risk of interference between TENS and the ICD function. Thirty patients who had received an ICD underwent a test protocol including TENS at the mammilla and hip levels, at two energy levels, and at the highest comfortable stimulation level. The effects of TENS on the electrocardiogram lead II, intracardiac electrograms, and the ICD marker channels were analyzed. Disturbance from TENS on the sensing function was seen at all stimulation attempts. Interference between the systems was observed in 16 patients. In eight patients (27%) the interpretation was VT/VF and in 14 patients (47%) as ventricular premature extra beats. Other kinds of interactions were seen in five patients (16%). Each patient could have more than one kind of interference. Noise reversion and undersensing might prevent the ICD from delivering shock when it should and the interpretation as VT/VF could result in inappropriate shocks. Because of the potentially serious consequences of interference we do not recommend the use of TENS in patients with ICD.

Transcutaneous Electrical Nerve Stimulation Reduces Acute Low Back Pain during Emergency Transport

Patients with acute low back pain may require emergency transport because of pain and immobilization. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmaceutical therapy for patients with low back pain. To evaluate the efficacy of paramedic-administered TENS in patients with acute low back pain during emergency transport. This was a prospective, randomized study involving 74 patients transported to hospital. The patients were randomly assigned to two groups: group 1 (n = 36) was treated with true TENS, while group 2 (n = 36) was treated with sham TENS. The authors recorded pain and anxiety as the main outcome variables using a visual analog scale (VAS). The authors recorded a significant (p < 0.01) pain reduction (mean +/- standard deviation) during transport in group 1 (79.2 +/- 6.5 mm VAS to 48.9 +/- 8.2 mm VAS), whereas pain scores remained unchanged in group 2 (75.9 +/- 16.4 mm VAS and 77.1 +/- 11.2 mm VAS). Similarly, the scores for anxiety were significantly reduced (p < 0.01) in group 1 (81.7 +/- 7.9 mm VAS to 69.2 +/- 12.1 mm VAS) after treatment. No significant change was noted (84.5 +/- 5.8 mm VAS and 83.5 +/- 8.9 mm VAS, respectively) in group 2. TENS was found to be effective and rapid in reducing pain during emergency transport of patients with acute low back pain and should be considered due to its ease of use and lack of side effects in the study population.

Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation

Diabetic distal symmetrical sensory polyneuropathy (DSP) affects 20-30% of diabetic patients. Transcutaneous electrical nerve stimulation (TENS) and electrical spinal cord stimulation have been proposed as physical therapies. We performed a controlled, randomised pilot trial to compare the effects of high-frequency external muscle stimulation (HF) with those of TENS in patients with symptomatic DSP. Patients with type 2 diabetes and DSP (n=41) were randomised to receive treatment with TENS or HF using strata for non-painful (n=20) and painful sensory symptoms (n=21). Both lower extremities were treated for 30 min daily for three consecutive days. The patients' degree of symptoms and pain were graded daily on a scale of one to ten, before, during and 2 days after treatment termination. Responders were defined by the alleviation of one or more symptoms by at least three points. The two treatment groups were similar in terms of baseline characteristics, such as age, duration of diabetes, neurological symptoms scores and neurological disability scores. The responder rate was significantly higher (p<0.05) in the HF group (80%, 16 out of 20) than in the TENS group (33%, seven out of 21). Subgroup analysis revealed that HF was more effective than TENS in relieving the symptoms of non-painful neuropathy (HF: 100%, seven out of seven; TENS: 44%, four out of nine; p<0.05) and painful neuropathy (HF: 69%, nine out of 13; TENS: 25%, three out of 12; p<0.05). The responders did not differ in terms of the reduction in mean symptom intensity during the trial. This pilot study shows, for the first time, that HF can ameliorate the discomfort and pain associated with DSP, and suggests that HF is more effective than TENS. External muscle stimulation offers a new therapeutic option for DSP.

Analgesic Efficacy of Transcutaneous Electrical Nerve Stimulation Compared with Diclofenac Sodium in Osteo-arthritis of the Knee

The role of drug treatment in osteo-arthritis is controversial. Comparatively few drugs are thought to affect the outcome of the disease process. Nevertheless non-steroidal anti-inflammatory drugs are, in most cases, the major weapon used by clinicians to relieve symptoms of the disease. There is some evidence that transcutaneous electrical nerve stimulation (TENS) is an effective and safe alternative to non-steroidal anti-inflammatory drugs in treatment of osteo-arthritis of the knee joint. It is non-invasive, non-toxic, inexpensive, portable and easy to apply. However there are conflicting reports of its efficacy, with little research to evaluate the effects of TENS as a primary single modality treatment, the relationship between the therapeutic benefits of TENS and pain severity has received little attention, and significant inter-subject variation in pain response can be expected. A single-blind trial of 60 patients was planned. Thirty-five completed the trial successfully. Before treatment a haemogram, blood chemistry tests and radiography of the affected knee were performed in addition to a thorough clinical examination where patients were selected for inclusion. After withdrawing all drugs for one week, patients were interviewed to record pain intensity on a simple descriptive scale and the distance they reported that they could walk comfortably. Each of the three phases of trial lasted for two weeks followed by a week's wash-out period. In phase 1 patients received both a placebo drug and placebo TENS. In phase 2 placebo TENS was combined with diclofenac sodium 50 mg three times a day. In phase 3 active TENS and the placebo drug were combined. Active TENS was applied in two 20-minute sessions daily for two weeks followed by assessment of pain intensity and the distance that patients reported they could walk. Though there was effective analgesia after placebo treatment as reported in many other studies, the analgesia produced by diclofenac sodium was greater (p < 0.05) when compared to the placebo. The analysis of phases 2 and 3, phases 2 and 1, and phases 3 and 1 revealed significant pain relief (p < 0.001) and improved walking (p < 0.001) after TENS in patients with mild to moderate pain and movement restriction. After phases 1 and 2 a marginal increase in ambulation (p < 0.05) was observed. TENS therapy was however not very effective in severely afflicted patients. The role of drug treatment in osteo-arthritis is controversial. Comparatively few drugs are thought to affect the outcome of the disease process. Nevertheless non-steroidal anti-inflammatory drugs are, in most cases, the major weapon used by clinicians to relieve symptoms of the disease. There is some evidence that transcutaneous electrical nerve stimulation (TENS) is an effective and safe alternative to non-steroidal anti-inflammatory drugs in treatment of osteo-arthritis of the knee joint. It is non-invasive, non-toxic, inexpensive, portable and easy to apply. However there are conflicting reports of its efficacy, with little research to evaluate the effects of TENS as a primary single modality treatment, the relationship between the therapeutic benefits of TENS and pain severity has received little attention, and significant inter-subject variation in pain response can be expected. A single-blind trial of 60 patients was planned. Thirty-five completed the trial successfully. Before treatment a haemogram, blood chemistry tests and radiography of the affected knee were performed in addition to a thorough clinical examination where patients were selected for inclusion. After withdrawing all drugs for one week, patients were interviewed to record pain intensity on a simple descriptive scale and the distance they reported that they could walk comfortably. Each of the three phases of trial lasted for two weeks followed by a week's wash-out period. In phase 1 patients received both a placebo drug and placebo TENS. In phase 2 placebo TENS was combined with diclofenac sodium 50 mg three times a day. In phase 3 active TENS and the placebo drug were combined. Active TENS was applied in two 20-minute sessions daily for two weeks followed by assessment of pain intensity and the distance that patients reported they could walk. Though there was effective analgesia after placebo treatment as reported in many other studies, the analgesia produced by diclofenac sodium was greater (p < 0.05) when compared to the placebo. The analysis of phases 2 and 3, phases 2 and 1, and phases 3 and 1 revealed significant pain relief (p < 0.001) and improved walking (p < 0.001) after TENS in patients with mild to moderate pain and movement restriction. After phases 1 and 2 a marginal increase in ambulation (p < 0.05) was observed. TENS therapy was however not very effective in severely afflicted patients.