Transcutaneous electrical nerve stimulation (TENS) for pain management in sickle cell disease

Pal, Sudipta; Dixit, Ramakant; Moe, Soe; Godinho, Myron Anthony; Abas, Adinegara BL; Ballas, Samir K.; Ram, Shanker; Yousuf, Uduman Ali Mohamed

doi:10.1002/14651858.cd012762.pub2

Cited by 9 publications

(8 citation statements)

References 45 publications

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“…However, studies comparing high-frequency and low-frequency TENS are insufficient to conduct further analysis. Usually, in low-frequency TENS settings, the TENS unit delivers low-frequency stimulus at a high stimulus intensity, which is close to the tolerance limit of the individual (Pal et al, 2020). Therefore, the low-frequency TENS is inevitably uncomfortable and is often considered for those who do not respond to high-frequency TENS (Pal et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…The mainstay of interventions for neuropathic pain is primarily pharmacological (Dworkin et al, 2013); however, for the large number of patients who cannot benefit from pharmacological intervention or who experience unwanted side effects, improving the ability to effectively relieve neuropathic pain with a non-pharmacological intervention such as psychological or physical treatment is crucial (Somers and Clemente, 2009;Gibson et al, 2017). Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, safe, easy to administer, portable, and inexpensive technique that delivers pulsed electrical stimulation, which can be modified regarding frequency, current intensity, and duration, via two or more skin electrodes to stimulate underlying nerves for pain control and has an advantage of allowing patients to control their pain autonomously (Pal et al, 2020). The antinociceptive effect of TENS may involve peripheral receptors (Santos et al, 2013), spinal (Melzack and Wall, 1965;Wall and Sweet, 1967), and supraspinal mechanisms (Kalra et al, 2001;DeSantana et al, 2008DeSantana et al, , 2009.…”

Section: Introductionmentioning

confidence: 99%

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Transcutaneous Electrical Nerve Stimulation in Rodent Models of Neuropathic Pain: A Meta-Analysis

et al. 2022

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Transcutaneous electrical nerve stimulation (TENS) is a non-invasive therapeutic intervention that is typically used for many years to treat chronic pain in patients who are refractory to pain medications. However, evidence of the efficacy of TENS treatment for neuropathic pain is lacking in humans. To further understand the efficacy of TENS under various intervention conditions and illuminate the current circumstance and future research directions, we systematically reviewed animal studies investigating the efficacy of TENS in relieving pain in neuropathic pain rodent models. We searched the Cochrane Library, EMBASE, MEDLINE (via PubMed), and Web of Science and identified 11 studies. Two meta-analyses were performed. The first meta-analysis showed that a single TENS treatment was capable of temporarily ameliorating neuropathic pain when compared to control groups with a significant effect (standardized mean difference: 1.54; 95% CI: 0.65, 2.42; p = 0.0007; I2 = 58%). Significant temporary alleviation in neuropathic pain intensity was also observed in the meta-analysis of repetitive TENS (standardized mean difference: 0.85; 95% CI: 0.31, 1.40; p = 0.002; I2 = 75%). Subgroup analysis showed no effect of the timing of the application of TENS (test for subgroup difference, p = 0.47). Leave-one-out sensitivity analyses suggested that no single study had an outsized effect on the pooled estimates, which may partly prove the robustness of these findings. Other stratified analyses were prevented by the insufficient number of included studies. Overall, current data suggest that TENS might be a promising therapy to ameliorate neuropathic pain. However, the high risk of bias in the included studies suggests that cautions must be considered when interpreting these findings and it is not reasonable to directly generalize the results obtained from animal studies to clinical practice. Future studies should pay more attention to improving the quality of study design and reporting, thereby facilitating the understanding of mechanisms underlying TENS treatment, reducing more potentially unsuccessful clinical trials, and optimizing the efficacy of TENS for people with neuropathic pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transcutaneous Electrical Nerve Stimulation in Rodent Models of Neuropathic Pain: A Meta-Analysis

et al. 2022

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“…There was also no difference between the groups in the amount of analgesics used. Moreover, given the very low quality of the evidence, the authors could not conclude on the superiority of TENS in improving overall satisfaction compared with “sham” TENS [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerance of Vascular Electrical Stimulation Therapy in the Management of Vaso-Occlusive Crises in Patients with Sickle Cell Disease: A Phase II Single-Centre Randomized Study in Ivory Coast

Botti

Bokoum

L’Hermite³

et al. 2021

Advances in Hematology

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Background. Vaso-occlusive crisis (VOC) is the primary cause of hospitalization in patients with sickle cell disease. Treatment mainly consists of intravenous morphine or nonsteroidal anti-inflammatory drugs (NSAIDs), which have many dose-related side effects. The question arises as to whether vascular electrical stimulation therapy (VEST) could be effective or not on VOCs. Objective. To measure the effectiveness and safety of VEST in reducing the median time spent in severe VOC. Methods. We conducted a phase II, single blinded, randomized, controlled, triple-arm, comparative trial. We included thirty (30) adult patients with severe vaso-occlusive crisis. The study arms were divided as follows: our control group (group 0) constituted of 10 patients followed with conventional therapy (Analgesics + Hydration + NSAIDs), while 20 patients were divided equally into two interventional arms—10 patients followed with VEST + Analgesics + Hydration (group 1) and the other 10 patients followed with VEST + Analgesics + Hydration + NSAIDs (group 2). The primary efficacy endpoint was median time to severe crisis elimination. The secondary end points were median time to end-of-crisis, median tramadol consumption, progress of the haemoglobin level over 3 days, side effects, and treatment failure. Results. The age ranged from 14 to 37 years, including 23 women. We noted a beneficial influence of the VEST on the median time to severe crisis (VAS greater than 2) elimination; 17 hours (group 1) against 3.5 hours (group 2) p = 0.0166 and 4 hours (group 3) with p value = 0.0448. Similar significant results were obtained on the diminution of total duration of the crisis (VAS over 0) and median tramadol consumption in patients in the interventional arms. Conclusion. These statistically significant results in the interventional arms suggest that VEST could be an alternative treatment of VOC in sickle cell patients.

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“…Acute pains included procedural pains during cervical laser surgery, venipuncture, and sigmoidoscopy; and pain associated with post-partum uterine contractions and rib fractures [ 66 ]. There is a paucity of evidence to determine whether TENS is beneficial for the management of episodes of acute pain during sickle cell disease [ 67 ], dysmenorrhoea [ 68 ] and angina [ 69 ].…”

Section: Long-standing Uncertainty: Efficacy and Effectivenessmentioning

confidence: 99%

Resolving Long-Standing Uncertainty about the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome

Johnson

2021

Medicina

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Pain is managed using a biopsychosocial approach and pharmacological and non-pharmacological treatments. Transcutaneous electrical nerve stimulation (TENS) is a technique whereby pulsed electrical currents are administered through the intact surface of the skin with the intention of alleviating pain, akin to ‘electrically rubbing pain away’. Despite over 50 years of published research, uncertainty about the clinical efficacy of TENS remains. The purpose of this comprehensive review is to critically appraise clinical research on TENS to inform future strategies to resolve the ‘efficacy-impasse’. The principles and practices of TENS are described to provide context for readers unfamiliar with TENS treatment. The findings of systematic reviews evaluating TENS are described from a historical perspective to provide context for a critical evaluation of factors influencing the outcomes of randomized controlled trials (RCTs); including sample populations, outcome measures, TENS techniques, and comparator interventions. Three possibilities are offered to resolve the impasse. Firstly, to conduct large multi-centered RCTs using an enriched enrolment with randomized withdrawal design, that incorporates a ‘run-in phase’ to screen for potential TENS responders and to optimise TENS treatment according to individual need. Secondly, to meta-analyze published RCT data, irrespective of type of pain, to determine whether TENS reduces the intensity of pain during stimulation, and to include a detailed assessment of levels of certainty and precision. Thirdly, to concede that it may be impossible to determine efficacy due to insurmountable methodological, logistical and financial challenges. The consequences to clinicians, policy makers and funders of this third scenario are discussed. I argue that patients will continue to use TENS irrespective of the views of clinicians, policy makers, funders or guideline panel recommendations, because TENS is readily available without prescription; TENS generates a pleasant sensory experience that is similar to easing pain using warming and cooling techniques; and technological developments such as smart wearable TENS devices will improve usability in the future. Thus, research is needed on how best to integrate TENS into existing pain management strategies by analyzing data of TENS usage by expert-patients in real-world settings.

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Transcutaneous electrical nerve stimulation (TENS) for pain management in sickle cell disease

Abstract: This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of TENS for managing pain in people with SCD who experience pain crises or chronic pain (or both), along with any possible adverse effects.

Cited by 9 publications

References 45 publications

Transcutaneous Electrical Nerve Stimulation in Rodent Models of Neuropathic Pain: A Meta-Analysis

Transcutaneous Electrical Nerve Stimulation in Rodent Models of Neuropathic Pain: A Meta-Analysis

Efficacy and Tolerance of Vascular Electrical Stimulation Therapy in the Management of Vaso-Occlusive Crises in Patients with Sickle Cell Disease: A Phase II Single-Centre Randomized Study in Ivory Coast

Resolving Long-Standing Uncertainty about the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome

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