TENS

J Rehabil Med. 2004 Sep;36(5):220-5.

Optimal stimulation frequency of

transcutaneous electrical nerve
stimulation on people with knee
osteoarthritis.
Law PP1, Cheing GL.

Author information
Abstract
OBJECTIVE:
This is a double blind study that examined the optimal stimulation frequency of
transcutaneous electrical nerve stimulation in reducing pain due to knee osteoarthritis.
SUBJECTS:
Thirty-four subjects were randomly allocated into 4 groups receiving transcutaneous
electrical nerve stimulation at either: (i) 2 Hz; (ii) 100 Hz; (iii) an alternating frequency
of 2 Hz and 100 Hz (2/100 Hz); or (iv) a placebo transcutaneous electrical nerve
stimulation.
METHODS:
Treatment was administered 5 days a week for 2 weeks. The outcome measures included:
(i) a visual analogue scale; (ii) a timed up-and-go test; and (iii) a range of knee motion.
RESULTS:
The 3 active transcutaneous electrical nerve stimulation groups (2 Hz, 100 Hz, 2/100 Hz),
but not the placebo group, significantly reduced osteoarthritic knee pain across treatment
sessions. However, no significant between-group difference was found. Similarly, the 3
active transcutaneous electrical nerve stimulation groups, but not the placebo group,
produced significant reductions in the amount of time required to perform the timed upand-go test, and an increase in the maximum passive knee range of motion.
CONCLUSION:

Our findings suggested that 2 weeks of repeated applications of transcutaneous electrical

nerve stimulation at 2 Hz, 100 Hz or 2/100 Hz produced similar treatment effects for
people suffering from osteoarthritic knee.
PMID:
15626162
[PubMed - indexed for MEDLINE]

ochrane Database Syst Rev. 2009 Oct 7;(4):CD002823. doi:

10.1002/14651858.CD002823.pub2.

Transcutaneous electrostimulation for

osteoarthritis of the knee.
Rutjes AW1, Nesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, Brosseau L,
Reichenbach S, Jni P.

Author information
Abstract
BACKGROUND:
Osteoarthritis is the most common form of joint disease and the leading cause of pain and
physical disability in the elderly. Transcutaneous electrical nerve stimulation (TENS),
interferential current stimulation and pulsed electrostimulation are used widely to control
both acute and chronic pain arising from several conditions, but some policy makers
regard efficacy evidence as insufficient.
OBJECTIVES:
To compare transcutaneous electrostimulation with sham or no specific intervention in
terms of effects on pain and withdrawals due to adverse events in patients with knee
osteoarthritis.
SEARCH STRATEGY:
We updated the search in CENTRAL, MEDLINE, EMBASE, CINAHL and PEDro up to
5 August 2008, checked conference proceedings and reference lists, and contacted
authors.
SELECTION CRITERIA:

Randomised or quasi-randomised controlled trials that compared transcutaneously

applied electrostimulation with a sham intervention or no intervention in patients with
osteoarthritis of the knee.
DATA COLLECTION AND ANALYSIS:
We extracted data using standardised forms and contacted investigators to obtain missing
outcome information. Main outcomes were pain and withdrawals or dropouts due to
adverse events. We calculated standardised mean differences (SMDs) for pain and
relative risks for safety outcomes and used inverse-variance random-effects metaanalysis. The analysis of pain was based on predicted estimates from meta-regression
using the standard error as explanatory variable.
MAIN RESULTS:
In this update we identified 14 additional trials resulting in the inclusion of 18 small trials
in 813 patients. Eleven trials used TENS, four interferential current stimulation, one both
TENS and interferential current stimulation, and two pulsed electrostimulation. The
methodological quality and the quality of reporting was poor and a high degree of
heterogeneity among the trials (I(2) = 80%) was revealed. The funnel plot for pain was
asymmetrical (P < 0.001). The predicted SMD of pain intensity in trials as large as the
largest trial was -0.07 (95% CI -0.46 to 0.32), corresponding to a difference in pain scores
between electrostimulation and control of 0.2 cm on a 10 cm visual analogue scale. There
was little evidence that SMDs differed on the type of electrostimulation (P = 0.94). The
relative risk of being withdrawn or dropping out due to adverse events was 0.97 (95% CI
0.2 to 6.0).
AUTHORS' CONCLUSIONS:
In this update, we could not confirm that transcutaneous electrostimulation is effective for
pain relief. The current systematic review is inconclusive, hampered by the inclusion of
only small trials of questionable quality. Appropriately designed trials of adequate power
are warranted.
Cochrane Database Syst Rev. 2001;(2):CD003008.

Transcutaneous electrical nerve

stimulation (TENS) for chronic low
back pain.
Milne S1, Welch V, Brosseau L, Saginur M, Shea B, Tugwell P, Wells G.

Author information

Abstract
BACKGROUND:
Low back pain (LBP) affects a large proportion of the population. Transcutaneous
electrical nerve stimulation (TENS) was introduced more than 30 years ago as an
alternative therapy to pharmacological treatments for chronic pain. However, despite its
widespread use, the effectiveness of TENS is still controversial.
OBJECTIVES:
The aim of this systematic review was to determine the efficacy of TENS in the treatment
of chronic LBP.
SEARCH STRATEGY:
We searched MEDLINE, EMBASE, PEDro and the Cochrane Controlled Trials Register
up to June 1, 2000.
SELECTION CRITERIA:
Only randomized controlled clinical trials of TENS for the treatment of patients with a
clinical diagnosis of chronic LBP were included. Abstracts were excluded unless further
data could be obtained from the authors.
DATA COLLECTION AND ANALYSIS:
Two reviewers independently selected trials and extracted data using predetermined
forms. Heterogeneity was tested with Cochran's Q test. A fixed effects model was used
throughout for continuous variables, except where heterogeneity existed, in which case, a
random effects model was used. Results are presented as weighted mean differences
(WMD) with 95% confidence intervals (95% CI), where the difference between the
treated and control groups was weighted by the inverse of the variance. Standardized
mean differences (SMD) were calculated by dividing the difference between the treated
and control by the baseline variance. SMD were used when different scales were used to
measure the same concept. Dichotomous outcomes were analyzed with odds ratios.
MAIN RESULTS:
Five trials were included, with 170 subjects randomized to the placebo group receiving
sham-TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for
acupuncture-like TENS). The schedule of treatments varied greatly between studies
ranging from one treatment/day for two consecutive days, to three treatments/day for four
weeks. There were no statistically significant differences between the active TENS group
when compared to the placebo TENS group for any outcome measures. Subgroup
analysis performed on TENS application and methodological quality did not demonstrate

a significant statistical difference. Remaining pre-planned subgroup analysis was not

conducted due to the small number of included trials and the variety of outcome measures
reported.
REVIEWER'S CONCLUSIONS:
The results of the meta-analysis present no evidence to support the use of TENS in the
treatment of chronic low back pain. Clinicians and researchers should consistently report
the characteristics of the TENS device and the application techniques used. New trials on
TENS should make use of standardized outcome measures. This meta-analysis lacked
data on how TENS effectiveness is affected by four important factors: type of
applications, site of application, treatment duration of TENS, optimal frequencies and
intensities.
PMID:
11406059
[PubMed - indexed for MEDLINE]

Abstract

Send to:
Spine (Phila Pa 1976). 2002 Mar 15;27(6):596-603.

Efficacy of the transcutaneous electrical

nerve stimulation for the treatment of
chronic low back pain: a meta-analysis.
Brosseau L1, Milne S, Robinson V, Marchand S, Shea B, Wells G, Tugwell P.

Author information
Abstract
BACKGROUND:
Low back pain affects a large proportion of the population. Transcutaneous electrical
nerve stimulation (TENS) was introduced more than 30 years ago as an alternative
therapy to pharmacologic treatments for chronic pain. However, despite its widespread
use, the efficacy of TENS is still controversial.
PURPOSE:

The aim of this meta-analysis was to determine the efficacy of TENS in the treatment of
chronic low back pain.
METHODS:
The authors searched MEDLINE, EMBASE, PEDro, and the Cochrane Controlled Trials
Register up to June 1, 2000. Only randomized controlled clinical trials of TENS for the
treatment of patients with a clinical diagnosis of chronic low back pain were included.
Abstracts were excluded unless further data could be obtained from the authors. Two
reviewers independently selected trials and extracted data using predetermined forms.
DATA ANALYSIS:
Heterogeneity was tested with Cochrane's Q test. A fixed effects model was used
throughout for continuous variables, except where heterogeneity existed, in which case, a
random effects model was used. Results are presented as weighted mean differences with
95% confidence intervals, where the difference between the treated and control groups
was weighted by the inverse of the variance. Standardized mean differences were
calculated by dividing the difference between the treated and control by the baseline
variance. Standardized mean differences were used when different scales were integrated
to measure the same concept. Dichotomous outcomes were analyzed with odds ratios.
MAIN RESULTS:
Five trials were included, with 170 subjects randomized to the placebo group receiving
sham TENS and 251 subjects receiving active TENS (153 for conventional mode, 98 for
acupuncture-like TENS). The schedule of treatments varied greatly between studies
ranging from one treatment/day for 2 consecutive days, to three treatments/day for 4
weeks. There were no statistically significant differences between the active TENS group
compared with the placebo TENS group for any outcome measures. Subgroup analysis
performed on TENS application and methodologic quality did not demonstrate a
significant statistical difference (P > 0.05). Remaining preplanned subgroup analysis was
not conducted because of the small number of included trials and the variety of outcome
measures reported.
CONCLUSION:
The results of the meta-analysis present no evidence to support the use or nonuse of
TENS alone in the treatment of chronic low back pain. Considering the small number of
studies responding to the criteria to be included in this meta-analysis, it is clear that more
appropriately designed studies are needed before a final conclusion. Clinicians and
researchers should consistently report the characteristics of the TENS device and the
application techniques used. New trials on TENS should make use of standardized
outcome measures. This meta-analysis lacked data on how TENS efficacy is affected by
four important factors: type of applications, site of application, treatment duration of
TENS, and optimal frequencies and intensities.

PMID:
11884907
[PubMed - indexed for MEDLINE]

Abstract

Send to:
Cochrane Database Syst Rev. 2001;(3):CD003222.

Transcutaneous electrical nerve

stimulation (TENS) for chronic pain.
Carroll D1, Moore RA, McQuay HJ, Fairman F, Tramr M, Leijon G.

Author information
Update in

Transcutaneous electrical nerve stimulation (TENS) for chronic pain. [Cochrane

Database Syst Rev. 2008]

Abstract
BACKGROUND:
Transcutaneous electrical nerve stimulation (TENS) is used in a variety of different
clinical settings to treat a range of different acute and chronic pain conditions and has
become popular with both patients and health professionals.
OBJECTIVES:
To evaluate the effectiveness of TENS in chronic pain.
SEARCH STRATEGY:
The Cochrane Library, Embase, Medline, CINAHL and The Oxford Pain Database were
searched. Reference lists from retrieved reports and reviews were examined. Date of the
most recent search: March 1999.
SELECTION CRITERIA:

RCTs were eligible if they included the following treatment comparisons: active TENS
versus sham TENS controls active TENS versus no treatment controls active TENS
versus active TENS controls (for instance High Frequency TENS vs Low Frequency
TENS) Studies of patients suffering chronic pain for three months or more which
included subjective outcome measures for pain intensity, or pain relief were eligible for
evaluation in this review. No restrictions were made to language or sample size. Data
from abstracts, letters, or unpublished studies, and studies of TENS in angina, headache
and migraine, and dysmenorrhoea were not included.
DATA COLLECTION AND ANALYSIS:
Data were extracted and summarised on the following items: patients and details of pain
condition, study treatments, study duration, design, methods, subjective pain outcome
measures, methodological quality, results for pain outcome measures and adverse effects,
and the conclusions made by the authors of the original studies. Extracted data and
methodological quality of each report was confirmed by at least three of the reviewers.
MAIN RESULTS:
Of 107 reports identified from the searches, 88 were excluded as they did not fulfil the
pre-defined entry criteria. Nineteen RCTs (from 18 reports) were evaluated. The included
trials varied in terms of design, analgesic outcomes, chronic pain conditions, TENS
treatments and overall methodological quality. Studies included single and multiple dose
treatment comparisons of TENS. The studies were small. The reporting of the methods
used and results for the analgesic outcomes were generally poor. TENS treatments and
controls were often poorly defined. Few studies evaluated the long-term analgesic
effectiveness of TENS and single dose evaluations of TENS are unhelpful in making
clinical decisions of the long-term effectiveness of TENS in the management of chronic
pain. Meta-analysis was not possible. Overall in 10 of 15 inactive control studies there
was a positive analgesic outcome in favour of the active TENS treatments. For the
multiple dose treatment comparison studies only three of seven were considered to be in
favour of the active TENS treatments. For the active controlled studies, seven studies
made direct comparisons between HFTENS and LFTENS. Five of seven studies could
find no difference in terms of analgesic efficacy between HFTENS and LFTENS at any
time point.
REVIEWER'S CONCLUSIONS:
The results of this review are inconclusive; the published trials do not provide
information on the stimulation parameters which are most likely to provide optimum pain
relief, nor do they answer questions about long-term effectiveness. Large multi-centre
randomised controlled trials of TENS in chronic pain are urgently needed.

Cochrane Database Syst Rev. 2012 Mar 14;3:CD006276. doi:

10.1002/14651858.CD006276.pub3.

Transcutaneous electric nerve stimulation

(TENS) for cancer pain in adults.
Hurlow A1, Bennett MI, Robb KA, Johnson MI, Simpson KH, Oxberry SG.

Author information
Abstract
BACKGROUND:
Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain
management has predominantly used a biomedical approach. There is a need for nonpharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation
(TENS) may have a role in pain management but the effectiveness of TENS is currently
unknown. This is an update of the original review published in Issue 3, 2008.
OBJECTIVES:
The aim of this systematic review was to determine the effectiveness of TENS for cancerrelated pain in adults.
SEARCH METHODS:
The initial review searched The Cochrane Library, MEDLINE, EMBASE, CINAHL,
PsychINFO, AMED and PEDRO databases in April 2008. We performed an updated
search of CENTRAL, MEDLINE, EMBASE, CINAHL and PEDRO databases in
November 2011.
SELECTION CRITERIA:
We included only randomised controlled trials (RCTS) investigating the use of TENS for
the management of cancer-related pain in adults.
DATA COLLECTION AND ANALYSIS:
The search strategy identified a further two studies for possible inclusion. One of the
review authors screened each abstract using a study eligibility tool. Where eligibility
could not be determined, a second author assessed the full paper. One author used a
standardised data extraction sheet to collect information on the studies and independently
assess the quality of the studies using the validated five-point Oxford Quality Scale. The

small sample sizes and differences in patient study populations of the three included
studies (two from the original review and a third included in this update) prevented metaanalysis. For the original review the search strategy identified 37 possible published
studies; we divided these between two pairs of review authors who decided on study
selection; all four review authors discussed and agreed final scores.
MAIN RESULTS:
Only one additional RCT met the eligibility criteria (24 participants) for this updated
review. Although this was a feasibility study, not designed to investigate intervention
effect, it suggested that TENS may improve bone pain on movement in a cancer
population. The initial review identified two RCTs (64 participants) therefore this review
now includes a total of three RCTs (88 participants). These studies were heterogenous
with respect to study population, sample size, study design, methodological quality, mode
of TENS, treatment duration, method of administration and outcome measures used. In
one RCT, there were no significant differences between TENS and placebo in women
with chronic pain secondary to breast cancer treatment. In the other RCT, there were no
significant differences between acupuncture-type TENS and sham in palliative care
patients; this study was underpowered.
AUTHORS' CONCLUSIONS:
Despite the one additional RCT, the results of this updated systematic review remain
inconclusive due to a lack of suitable RCTs. Large multi-centre RCTs are required to
assess the value of TENS in the management of cancer-related pain in adults.
Cochrane Database Syst Rev. 2008 Jul 16;(3):CD003222. doi:
10.1002/14651858.CD003222.pub2.

Transcutaneous electrical nerve

stimulation (TENS) for chronic pain.
Nnoaham KE1, Kumbang J.

Author information
Update in

WITHDRAWN: Transcutaneous electrical nerve stimulation (TENS) for chronic

pain. [Cochrane Database Syst Rev. 2014]

Abstract
BACKGROUND:

Transcutaneous electrical nerve stimulation (TENS) is a popular pain treatment modality

but its effectiveness in chronic pain management is unknown. This review is an update of
the original Cochrane review published in Issue 3, 2001.
OBJECTIVES:
To evaluate the effectiveness of TENS in chronic pain.
SEARCH STRATEGY:
The Cochrane Library, EMBASE, MEDLINE and CINAHL were searched. Reference
lists from retrieved reports and reviews were examined. Date of the most recent search:
April 2008.
SELECTION CRITERIA:
RCTs were eligible if they compared active TENS versus sham TENS controls; active
TENS versus 'no treatment' controls; or active TENS versus active TENS controls (e.g.
High Frequency TENS (HFTENS) versus Low Frequency TENS (LFTENS)). Studies of
chronic pain for three months or more which included subjective outcome measures for
pain intensity or relief were eligible for evaluation. No restrictions were made to
language or sample size. Abstracts, letters, or unpublished studies, and studies of TENS
in angina, headache, migraine, dysmenorrhoea and cancer-related pain were excluded.
DATA COLLECTION AND ANALYSIS:
Data were extracted and summarised on the following items: patients and details of pain
condition, treatments, study duration, design, methods, subjective pain outcome
measures, methodological quality, results for pain outcome measures and adverse effects,
and conclusions by authors of the studies. Extracted data and methodological quality of
studies were confirmed by the review authors.
MAIN RESULTS:
Of 124 studies identified from the searches, 99 did not fulfil pre-defined entry criteria.
Twenty-five RCTs involving 1281 participants were evaluated. Included studies varied in
design, analgesic outcomes, chronic pain conditions, TENS treatments and
methodological quality. The reporting of methods and results for analgesic outcomes
were inconsistent across studies and generally poor. Meta-analysis was not possible.
Overall in 13 of 22 inactive control studies, there was a positive analgesic outcome in
favour of active TENS treatments. For multiple dose treatment comparison studies, eight
of fifteen were considered to be in favour of the active TENS treatments. Seven of the
nine active controlled studies found no difference in analgesic efficacy between High
Frequency (HF) TENS and Low Frequency (LF) TENS.
AUTHORS' CONCLUSIONS:

Since the last version of this review, new relevant studies have not provided additional
information to change the conclusions. Published literature on the subject lacks the
methodological rigour or robust reporting needed to make confident assessments of the
role of TENS in chronic pain management. Large multi-centre RCTs of TENS in chronic
pain are still needed.

Update of

Transcutaneous electrical nerve stimulation (TENS) for chronic pain. [Cochrane

Database Syst Rev. 2001]

Transcutaneous electrical nerve

stimulation for acute pain.
Walsh DM1, Howe TE, Johnson MI, Sluka KA.

Author information
Update in

Transcutaneous electrical nerve stimulation for acute pain. [Cochrane Database

Syst Rev. 2015]

Abstract
BACKGROUND:
Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological agent,
based on delivering low voltage electrical currents to the skin. TENS is used for the
treatment of a variety of pain conditions.
OBJECTIVES:
To assess the analgesic effectiveness of TENS for acute pain in adults to see if it had any
clear analgesic effect in its own right.
SEARCH STRATEGY:
The following databases were searched: Cochrane Pain, Palliative and Supportive Care
Group Specialised Register; the Cochrane Central Register of Controlled Trials,
CENTRAL (in The Cochrane Library); MEDLINE; EMBASE; CINAHL; AMED;
PEDro; OTseeker; OpenSIGLE; and, reference lists of included studies. The most recent
search was undertaken in August 2008.

SELECTION CRITERIA:
Randomised controlled trials (RCTs) of adults with acute pain (less than 12 weeks) were
included if they examined TENS given as a sole treatment and assessed pain with
subjective pain scales. Studies were eligible if they compared TENS to placebo TENS, no
treatment controls, pharmacological interventions or non-pharmacological interventions.
Studies on experimental pain, case reports, clinical observations, letters, abstracts or
reviews were excluded. Studies on TENS and labour pain, pain due to dental procedures
and primary dysmenorrhoea were excluded. Studies where TENS was given with another
treatment as part of the formal study design were also excluded. No restrictions were
made regarding language.
DATA COLLECTION AND ANALYSIS:
Two authors independently assessed trial eligibility and extracted data. Data were
extracted on the following: types of participants and pain condition, study design and
methods, treatment parameters, adverse effects, and outcome measures. Study authors
were contacted for additional information if necessary.
MAIN RESULTS:
Of 1479 studies identified in the search, 132 were identified as relevant. Of these, 116
were excluded; the vast majority of these were excluded due to TENS being given with
another treatment. Four studies were categorised as awaiting classification as the
information provided in the full text failed to clarify their eligibility. Twelve RCTs
involving 919 participants at entry were included. The types of acute pain conditions
included procedural pain, e.g. cervical laser treatment, venipuncture, screening flexible
sigmoidoscopy and non-procedural pain, e.g. postpartum uterine contractions, rib
fractures. It was not possible to perform a meta-analysis due to insufficient data.
AUTHORS' CONCLUSIONS:
Due to insufficient extractable data in the studies included in this review, we are unable to
make any definitive conclusions about the effectiveness of TENS as an isolated treatment
for acute pain in adults.
PMID:
19370629
[PubMed - indexed for MEDLINE]

Cochrane Database Syst Rev. 2005 Jul 20;(3):CD003008.

Transcutaneous electrical nerve

stimulation (TENS) for chronic lowback pain.
Khadilkar A, Milne S, Brosseau L, Robinson V, Saginur M, Shea B, Tugwell P, Wells G.

Update in

Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic

low-back pain. [Cochrane Database Syst Rev. 2008]

Abstract
BACKGROUND:
Chronic low-back pain (LBP) affects a significant proportion of the population.
Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years
ago as an adjunct to the pharmacological management of pain. However, despite its
widespread use, the usefulness of TENS in chronic LBP is still controversial.
OBJECTIVES:
The aim of this systematic review was to determine the effectiveness of TENS in the
management of chronic LBP.
SEARCH STRATEGY:
We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2005),
MEDLINE, EMBASE and PEDro up to April 1, 2005.
SELECTION CRITERIA:
Only randomized controlled clinical trials (RCTs) evaluating the effect of TENS on
chronic LBP were included. Abstracts were excluded unless further data could be
obtained from the authors.
DATA COLLECTION AND ANALYSIS:
Two reviewers independently selected trials and extracted data using predetermined
forms. Heterogeneity was tested with Cochrane's Q test. A fixed effect model was used
throughout for calculating continuous variables, except where heterogeneity existed, in
which case, a random effects model was used. Results are presented as weighted mean
differences (WMD) with 95% confidence intervals (95% CI), where the difference

between the treated and control groups was weighted by the inverse of the variance.
Standardized mean differences (SMD) were calculated by dividing the difference
between the treated and control by the baseline variance. SMD were used when different
scales were used to measure the same concept. Dichotomous outcomes were analyzed
with odds ratios.
MAIN RESULTS:
The only two RCTs (175 patients) meeting eligibility criteria differed in study design,
methodological quality, inclusion and exclusion criteria, type and method of TENS
application, treatment schedule, co-interventions and final outcomes. In one RCT, TENS
produced significantly greater pain relief than the placebo control. However, in the other
RCT, no statistically significant differences between treatment and control groups were
shown for multiple outcome measures. Pre-planned subgroup analyses, intended to
examine the impact of different stimulation parameters, sites of TENS application,
treatment durations and baseline patient characteristics were not possible due to the small
number of included trials.
AUTHORS' CONCLUSIONS:
There is inconsistent evidence to support the use of TENS as a single treatment in the
management of chronic LBP. Larger, multi-center, randomized controlled trials are
needed to better assess the true effectiveness of TENS. Special attention should be given
to the risks and benefits of long-term use, which more appropriately addresses the
realities of managing chronic low-back pain.
PMID:
16034883
[PubMed - indexed for MEDLINE]
e Database Syst Rev. 2003;(3):CD004377.

Transcutaneous electrical nerve

stimulation (TENS) for the treatment of
rheumatoid arthritis in the hand.
Brosseau L1, Judd MG, Marchand S, Robinson VA, Tugwell P, Wells G, Yonge K.

Author information
Abstract
BACKGROUND:

Rheumatoid arthritis (RA) is a chronic, inflammatory, system disease. It commonly

affects the small peripheral joints (such as fingers and wrist). The main goals of
intervention for RA are preventing joint deformity, preserving joint function, and
reducing inflammation and pain. Transelectrical nerve stimulation (TENS) is a form of
electrotherapy and is thought to produce analgesia according to the gate control theory.
OBJECTIVES:
To determine the efficacy and safety of TENS in the treatment of RA of the hand. The
primary outcomes of interest were relief of grip pain and resting pain intensity, relief of
joint tenderness, number of tender joints and patient assessment of disease. The
secondary objective was to determine the most effective mode of TENS application in
pain control.
SEARCH STRATEGY:
We searched for relevant studies, in English, in the Cochrane field of physical and related
therapies, the Cochrane Controlled Trials Register, MEDLINE, EMBASE,
HEALTHSTAR, Sports Discus, CINAHL, Current Contents, and the PEDro database, up
to October 2002.
SELECTION CRITERIA:
Two independent reviewers selected the trials that met predetermined inclusion criteria.
DATA COLLECTION AND ANALYSIS:
Study results were extracted by two independent reviewers. Continuous outcomes were
analyzed by weighted mean difference (WMD) using a fixed effects model.
MAIN RESULTS:
Three RCTs, involving 78 people, were included in this review. AL-TENS and C-TENS
were compared to placebo and to each other. Administration of 15 minutes of AL-TENS a
week, for 3 weeks, resulted in a significant decrease in rest pain (67% relative benefit, 45
points absolute benefit on 100 mm VAS scale) but not in grip pain compared to placebo.
AL-TENS did result in a clinical beneficial improvement in muscle power scores with a
relative difference of 55%, and an absolute benefit of 0.98, compared to placebo. No
significant difference was found between one 20-minute treatment duration of C-TENS
versus AL-TENS, or C-TENS versus placebo on decrease in mean scores for rest pain or
grip pain, or on the number of tender joints. Results showed a statistically significant
reduction in joint tenderness, but no clinical benefit from C-TENS over placebo in relief
of joint tenderness. No statistically significant difference was shown between 15 days of
treatment with C-TENS or AL-TENS in relief of joint pain, although there was a
clinically important benefit of C-TENS over AL-TENS on patient assessment of change
in disease (risk difference 21%, NNT 5).

REVIEWER'S CONCLUSIONS:
There are conflicting effects of TENS on pain outcomes in patients with RA. AL-TENS is
beneficial for reducing pain intensity and improving muscle power scores over placebo
while, conversely, C-TENS resulted in no clinical benefit on pain intensity compared
with placebo. However C-TENS resulted in a clinical benefit on patient assessment of
change in disease over AL-TENS. More well designed studies with a standardized
protocol and adequate number of subjects are needed to fully conclude the effect of CTENS and AL-TENS in the treatment of RA of the hand.
PMID:
12918009
[PubMed - indexed for MEDLINE]
Cochrane Database Syst Rev. 2015 Jun 15;6:CD006142. doi:
10.1002/14651858.CD006142.pub3.

Transcutaneous electrical nerve

stimulation for acute pain.
Johnson MI1, Paley CA, Howe TE, Sluka KA.

Author information
Abstract
BACKGROUND:
This is a second update of a Cochrane Review originally published in Issue 2, 2009.
Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological agent,
based on delivering low voltage electrical currents to the skin. TENS is used by people to
treat a variety of pain conditions.
OBJECTIVES:
To assess the analgesic effectiveness of TENS, as a sole treatment, for acute pain in
adults.
SEARCH METHODS:
We searched the following databases up to 3 December 2014: the Cochrane Central
Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE;
EMBASE; CINAHL; and AMED. We also checked the reference lists of included trials.
SELECTION CRITERIA:

We included randomised controlled trials (RCTs) of adults with acute pain (< 12 weeks)
if they examined TENS given as a sole treatment and assessed pain with subjective pain
scales. Trials were eligible if they compared TENS to placebo TENS, no treatment
controls, pharmacological interventions or non-pharmacological interventions. We
excluded trials on experimental pain, case reports, clinical observations, letters, abstracts
or reviews. Also we excluded trials investigating the effect of TENS on pain during
childbirth (labour), primary dysmenorrhoea or dental procedures. Studies where TENS
was given with another treatment as part of the formal trial design were excluded. We did
not restrict any articles based on language of publication.
DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed study eligibility and carried out study
selection, data extraction, 'Risk of bias' assessment and analyses of data. We extracted
data on the following: types of participants and pain condition, trial design and methods,
treatment parameters, adverse effects, and outcome measures. We contacted trial authors
for additional information if necessary.
MAIN RESULTS:
We included 12 trials in the original review (2009) and included no further trials in the
first update (2011). An additional seven new trials met the inclusion criteria in this second
update. In total, we included 19 RCTs involving 1346 participants at entry, with 11 trials
awaiting classification either because the full text was unavailable or information in the
full text failed to clarify eligibility. We excluded most trials because TENS was given in
combination with another treatment as part of the formal study design or TENS was not
delivered using appropriate TENS technique. The types of acute pain included in this
Cochrane Review were procedural pain, e.g. cervical laser treatment, venepuncture,
screening flexible sigmoidoscopy and non-procedural pain, e.g. postpartum uterine
contractions and rib fractures. We pooled data for pain intensity for six trials (seven
comparisons) comparing TENS with placebo but the I(2) statistic suggested substantial
heterogeneity. Mean difference (MD) with 95% confidence intervals (CIs) on a visual
analogue scale (VAS, 100 mm) was -24.62 mm (95% CI -31.79 to -17.46) in favour of
TENS. Data for the proportion of participants achieving 50% reduction in pain was
pooled for four trials (seven comparisons) and relative risk was 3.91 (95% CI 2.42 to
6.32) in favour of TENS over placebo. We pooled data for pain intensity from five trials
(seven comparisons) but the I(2) statistic suggested considerable heterogeneity. MD was
-19.05 mm (95% CI -27.30 to -10.79) in favour of TENS using a random-effects model.
It was not possible to pool other data. There was a high risk of bias associated with
inadequate sample sizes in treatment arms and unsuccessful blinding of treatment
interventions. Seven trials reported minor adverse effects, such as mild erythema and
itching underneath the electrodes and participants disliking TENS sensation.
AUTHORS' CONCLUSIONS:

This Cochrane Review update includes seven new trials, in addition to the 12 trials
reviewed in the first update in 2011. The analysis provides tentative evidence that TENS
reduces pain intensity over and above that seen with placebo (no current) TENS when
administered as a stand-alone treatment for acute pain in adults. The high risk of bias
associated with inadequate sample sizes in treatment arms and unsuccessful blinding of
treatment interventions makes definitive conclusions impossible. There was incomplete
reporting of treatment in many reports making replication of trials impossible.

Update of

Transcutaneous electrical nerve stimulation for acute pain. [Cochrane Database

Syst Rev. 2009]

PMID:
26075732
[PubMed - in process]

Abstract

Send to:
Wiad Lek. 2015;68(1):13-9.

[Comparison of the analgesic effect of

interferential current (IFC) and TENS
in patients with low back pain].
[Article in Polish]
Grabiaska E, Leniewicz J, Pieszyski I, Kostka J.

Abstract
INTRODUCTION:
Electrotherapy, including theTENS and interferential current (IFC) is one of the most
frequently used treatments in physical therapy in patients with low back pain. The aim of
this study was to assess the influence of TENS and IFC on pain relief and to compare the
analgesic efficacy of the two currents.
MATERIAL AND METHODS:
Sixty patients aged 53.5 12.5, with low back pain, were randomly divided into two
groups: IFC (gr. I) and TENS (gr. II). Depending on the groups, patients were given

series of ten 20-minute sessions using either IF orTENS currents. In all patients VAS and
Laitinen modified scale were taken before and after treatment.
RESULTS:
After 2-weeks therapy there was improvement in the VAS and Laitinen scale (all
components) in both groups, except for the part of the Laitinen scale on the reduction of
activity in the group II (TENS). There was no statistically significant difference between
the TENS and IF groups in reducing the intensity and other aspects of pain (frequency,
pain medication and activity limitation) under the influence of therapy (p > 0.05).
CONCLUSIONS:
Interferential current and TENS therapy are effective for pain relief in patients with low
back pain. The study showed equal analgesic efficacy of both treatments.
PMID:
26094328
[PubMed - indexed for MEDLINE]
Clin Rehabil. 2003 Nov;17(7):742-9.

A pilot investigation of the hypoalgesic

effects of transcutaneous electrical
nerve stimulation upon low back pain
in people with multiple sclerosis.
Al-Smadi J1, Warke K, Wilson I, Cramp AF, Noble G, Walsh DM, Lowe-Strong AS.

Author information
Abstract
OBJECTIVE:
To investigate the hypoalgesic effects of transcutaneous electrical nerve stimulation
(TENS) upon low back pain (LBP) in people with multiple sclerosis (MS).
DESIGN:
A randomized double-blind placebo controlled clinical pilot study.
SUBJECTS AND SETTING:

Fifteen people with MS were recruited and randomly allocated to one of the following
groups under double blind conditions (n = 5 per group): TENS 1 (4 Hz, 200 micros),
TENS 2 (110 Hz, 200 micros), placebo TENS.
INTERVENTIONS:
Treatment was applied for 45 minutes three times a week for six weeks with a four-week
follow-up.
OUTCOME MEASURES:
The following outcome measures were taken at weeks 1, 6, and 10: visual analogue scale
(VAS) (for current LBP, right leg pain, left leg pain); Leeds Multiple Sclerosis Quality of
Life Questionnaire; Roland Morris Disability Questionnaire; Short Form-36 (SF-36)
Version 1; and the McGill Pain Questionnaire (MPQ). VAS for current LBP, right and left
leg pain were also taken before and after treatment, and once a week during the follow-up
period.
RESULTS:
Analysis showed no statistically significant effects for any of the data. However, both
active treatment groups showed a trend of improvement in the majority of the outcome
measures.
CONCLUSION:
Active TENS was more effective than placebo TENS in decreasing VAS scores following
each treatment although results were not statistically significant. Further work in this area
is warranted and should include a larger number of participants in the form of a
randomized controlled clinical trial to determine the efficacy of this modality.
PMID:
14606740
[PubMed - indexed for MEDLINE]