Transcutaneous electrical nerve stimulation for advanced cancer pain inpatients in specialist palliative care—a blinded, randomized, sham-controlled pilot cross-over trial

Abstract

Purpose Transcutaneous electrical nerve stimulation (TENS) is a treatment option for cancer pain, but the evidence is inconclusive. We aimed to evaluate the efficacy and safety of TENS. Methods A blinded, randomized, sham-controlled pilot cross-over trial (NCT02655289) was conducted on an inpatient specialist palliative care ward. We included adult inpatients with cancer pain ≥ 3 on an 11-point numerical rating scale (NRS). Intensitymodulated high TENS (IMT) was compared with placebo TENS (PBT). Patients used both modes according to their preferred application scheme during 24 h with a 24-h washout phase. The primary outcome was change in average pain intensity on the NRS during the preceding 24 h. Responders were patients with at least a "slight improvement." Results Of 632 patients screened, 25 were randomized (sequence IMT-PBT = 13 and PBT-IMT = 12). Finally, 11 patients in IMT-PBT and 9 in PBT-IMT completed the study (N = 20). The primary outcome did not differ between groups (IMT minus PBT: − 0.2, 95% confidence interval − 0.9 to 0.6). However, responder rates were higher in IMT (17/20 [85%] vs. 10/20 [50%], p = 0.0428). Two patients experienced an uncomfortable feeling caused by the current, one after IMT and one after PBT. Seven patients (35%) desired a TENS prescription. Women and patients with incident pain were most likely to benefit from TENS. Conclusion TENS was safe, but IMT was unlikely to offer more analgesic effects than PBT. Even though many patients desired a TENS prescription, 50% still reported at least "slight pain relief" from PBT. Differences for gender and incident pain aspects demand future trials.

Role of Physiotherapy in Hospice Care of Patients with Advanced Cancer: A Systematic Review

“…Exercise therapy, 9 -13 electrotherapy, 14 massage therapy, 15 relaxation therapy 16 and compression bandaging 17 were the interventions included in this review. Five out of 9 studies evaluated the effect of various exercise interventions such as individualized exercise supervised by physiotherapist 9 ; group circuit training program comprising of 6 different exercises 10 ; a home-based functional walking program 11 ; cardiovascular and resistance exercises 12 and Duke Energizing Exercise plan (DEEP).…”

“…Although there was no significant difference in the intensity modulated TENS and placebo TENS, both showed efficacy, feasibility and were safe to use. 14 Another RCT conducted by Wilkie et al showed that administering therapeutic massage reduced the intensity of pain and decreased the dosage of analgesics in hospice care of patients with advanced cancer. 15 In a study conducted by Litterini et al, the effect of exercise showed minimal reduction in pain level post intervention.…”

Effects of Transcutaneous Electrical Nerve Stimulation on Pain and Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: A Systematic Review

“…Seven studies published between 2007 and 2020 were included in this SR [33,[35][36][37][38][39][40]. A summary of the findings is shown in Table 2.…”

Effects of electrical stimulation on skin surface

“…The number of fibroblasts (dark fusiform cells, F) was significantly higher in cathodal ES group compared with control group [63] role in the suppression of severe pain caused by many conditions [11]. Siemens et al [80] evaluated the effectiveness and safety of TENS therapy in the treatment of cancer pain, and conducted a single-blind experiment on patients. The results showed the safety of TENS, but the effectiveness is difficult to evaluate.…”