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

Abstract

Purpose Ocular pain is a debilitating condition that is challenging to treat as therapies that target the ocular surface are often ineffective. We previously reported a short‐term reduction in ocular pain after one periocular transcutaneous electrical nerve stimulation (TENS) session. The current study aims to elucidate the long‐term effect of TENS on ocular pain. Materials and Methods Fourteen individuals with eye pain were identified as candidates for a TENS device (RS Medical, Vancouver) for home use after a successful trial in clinic between February 2018 and July 2019 at the Miami Veterans Administration Hospital or University of Miami. Ten of the 14 patients were included in this retrospective review, based on the inclusion of receiving and using the device for a minimum of three months. The median age of the ten patients was 47.5 years, range 32–73 years, and eight were male. The main outcome measures were 1) frequency of long‐term integration of TENS into ocular pain management and 2) patient reported ocular pain intensity (0‐10) pre‐ vs. post‐treatment. Results Patients reported an initial median use of the device 14.0 times per week and over time reducing the frequency to 3.0 times per week. All reported that the TENS unit was successfully incorporated into their ocular pain management routine for at least three months (median duration of use 6.5 months, range 3–14 months). Nine of ten patients reported subjective pain reduction with use of the TENS device at home. Overall, pain intensity decreased by approximately 27.4% (mean rank = 5.6, Z = −2.1, p = 0.02) post‐ vs. pre‐treatment. No adverse events associated with TENS were reported in any patient. Conclusion Our preliminary data suggest that TENS can be integrated into the long‐term management of ocular pain with improvements in overall pain intensity.

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain

“…Overall, pain scores (one-week recall measured via NRS 0–10) decreased by 27.4% (p=0.02) post‐ vs pre‐treatment. 109 Together, these data suggest that TENS may be incorporated as an adjuvant treatment in individuals with dry eye and migraine.…”

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“…88 Other therapies that have been used in individuals with presumed neuropathic ocular pain include periocular nerve blocks (4 mL of 0.5% bupivacaine mixed with 1 mL of 80 mg/mL methylprednisolone acetate), 88 botulinum toxin injections 92 and transcutaneous electrical stimulation. 93 94 However, robust studies examining the effect of these modalities in this patient group are lacking and thus an important avenue of future investigations. Overall, in individuals with recalcitrant DED symptoms in the setting of a suspected abnormality in peripheral and/or central nerves, agents that can modulate nerve function should be considered.…”

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“…Hush et al [ 90 ] show that after thoracotomy in the intensive care unit (ICU), TENS adjuvant therapy can relieve pain in the first 12 h. As one of the difficult to treat diseases, eye pain usually cannot be relieved because of the difficulty of treating the ocular surface. In a recent TNES assisted long-term treatment of eye pain, the TENS experimental group reduced pain by 27.4% compared to the control group, which can assist in the treatment of eye pain [ 91 ]. Patellofemoral pain syndrome (PFPS) can cause muscle weakness and knee pain, which is a common disease among military personnel.…”