<p>Impact of transcutaneous electrical nerve stimulation on sleep in chronic low back pain: a real-world retrospective cohort study</p>

Abstract

Objective The purpose of this study was to determine if transcutaneous electrical nerve stimulation (TENS) improves sleep in chronic low back pain (CLBP). Background There is uncertainty over the effectiveness of TENS in CLBP. In most studies, pain intensity has been the primary outcome measure. Although sleep abnormalities are common in CLBP, sleep outcomes have not been evaluated in most studies of TENS effectiveness. Subjective and objective sleep measures are often inconsistent in CLBP, suggesting that perception of sleep and actual sleep may differ. Methods This retrospective cohort study evaluated TENS for CLBP over 10 weeks. The source database included demographics, pain characteristics, pain intensity and interference on an 11-point numerical rating scale, adherence and actigraphic sleep data from real-world TENS users. Key inclusion criteria were CLBP with self-reported history of back injury and baseline pain interference with sleep ≥4. Study participants were stratified into improved and unimproved groups based on changes in pain interference with sleep (improved ≥1-point decrease). Actigraphic sleep metrics were compared between the two groups for weeks 1–2 and weeks 9–10. Results The inclusion criteria were met by 554 TENS users. There were 282 (50.9%) participants in the improved group and 272 (49.1%) in the unimproved group. The two groups had similar baseline characteristics and high TENS adherence. At the weeks 1–2 assessment, there were no differences among actigraphic sleep. At the weeks 9–10 assessment, there was a difference in total sleep time, with the improved group sleeping 29 minutes longer. In addition, the periodic leg movement (PLM) index was lower in the improved group. Conclusion Regular TENS improved self-reported and objective sleep measures in individuals with CLBP. When compared to the unimproved group, the improved group had longer total sleep time and fewer PLMs. Sleep may be an important outcome for TENS effectiveness in CLBP.

Transcutaneous Electrical Nerve Stimulation for the Long-Term Treatment of Ocular Pain

“…Transcutaneous electrical nerve stimulation (TENS) is a noninvasive neuromodulating therapy that has been found to be effective in treating various chronic pain syndromes . After placing electrodes at the skin surface, electrical signals are transmitted that activate inhibitory interneurons and decrease nociceptor firing, ultimately resulting in inhibited transmission of ascending pain signals .…”

<p>Remote Analgesic Effects Of Conventional Transcutaneous Electrical Nerve Stimulation: A Scientific And Clinical Review With A Focus On Chronic Pain</p>

“…3,22,24,66,79,80 Finally, activation of brain areas comprising the pain matrix 76,77 could have profoundly widespread analgesic effects, as well as improve mood, sleep, and other functions. 25,26,81 Various neurotransmitters are involved in pain inhibition, including GABA, glycine, noradrenaline, serotonin, and opioids. 82 The most relevant to remote TENS analgesia are likely to be the opioids.…”

“…Gozani et al evaluated changes in self-reported and objective measures of sleep in 554 participants using conventional TENS located on the lower leg over 10 weeks. 26 All participants reported chronic low-back pain with a prior history of back injury. Average TENS use was 40 hours per week.…”

“…These devices can be embedded with sensors which feed algorithms that automatically regulate stimulation and track physiological outcomes. 26 Third, there is the potential to treat multisite pain from a single location or small number of sites. 22,27 A limitation of fixed sites is an inability to optimize stimulation location to each patient's pain distribution.…”

“…Recent abstracts and published studies have demonstrated innovative uses of conventional TENS applied remotely to pain or to evoke widespread pain relief. [22][23][24][25][26][32][33][34][35] The purpose of this narrative review is to examine mechanisms underlying these remote effects and to appraise the clinical evidence. This is an important topic, because these applications may motivate the development of treatments that increase the utility and adoption of noninvasive neuromodulation for chronic pain.…”