Using Tens for Pain Control: The State of the Evidence

Abstract

Summary Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacological intervention that activates a complex neuronal network to reduce pain by activating descending inhibitory systems in the central nervous system to reduce hyperalgesia. The evidence for TENS efficacy is conflicting and requires not only description but also critique. Population-specific systemic reviews and meta-analyses are emerging, indicating both HF and LF TENS being shown to provide analgesia, specifically when applied at a strong, nonpainful intensity. The purpose of this article is to provide a critical review of the latest basic science and clinical evidence for TENS. Additional research is necessary to determine if TENS has effects specific to mechanical stimuli and/or beyond reduction of pain and will improve activity levels, function and quality of life.

Direct and Indirect Benefits Reported by Users of Transcutaneous Electrical Nerve Stimulation for Chronic Musculoskeletal Pain: Qualitative Exploration Using Patient Interviews

“…The findings also indicated the value of a flexible approach to pad positioning and choice of settings including appropriate stimulation intensity 15 , that converges with recently published work highlighting the importance of these factors. 39,40 A particular strength of this research derives from the semi-structured interviews which encouraged users to express a wide range of experiences which other research methods may not have facilitated. The extensive experience of the participants contributes to the credibility of the data.…”

Basic Understanding of Transcutaneous Electrical Nerve Stimulation

“…35) However, others studies reported that blockade of peripheral opioid receptors prevented the analgesic effect produced by low, but not high frequency TENS. [35][36][37] In addition, it was known that a variety of neurotransmitters including endogenous ligand norepinephrine, GABA and serotonin were involved in analgesic actions of TENS.…”

“…11,34,35) It was also known that both TENS with high and low frequency have analgesic effects at the peripheral site by altering the excitability of peripheral nociceptors, thereby reducing pain input to the central nervous system. 35) However, others studies reported that blockade of peripheral opioid receptors prevented the analgesic effect produced by low, but not high frequency TENS. [35][36][37] In addition, it was known that a variety of neurotransmitters including endogenous ligand norepinephrine, GABA and serotonin were involved in analgesic actions of TENS.…”

<b>Different frequencies of transcutaneous electrical nerve stimulation on sympatho-vagal balance

“…The increased sympathetic activity is related to the risk of life (Marmar & Shivkumar, 2008), and interventions that decrease this activity reduce mortality from cardiovascular disease (ESC, 1996). In this context, TENS is presented as a potential therapeutic resource able to interact in different clinical conditions, such as hypertension, in addition to its analgesic effects widely described in literature (Chesterton et al, 2002;Sbruzzi et al, 2012;Vance et al, 2014;Bi et al, 2015). This interaction of TENS with the cardiovascular system is demonstrated by vasodilation (Cramp et al, 2000;Miller, Gruben, & Morgan, 2000;Sherry et al, 2001;Vieira et al, 2012), increased blood in peripheral and coronary blood flow (Chauhan et al, 1994;Jessurun et al, 1998;Cramp et al, 2000;Miller et al, 2000;Sandberg, Sandberg, & Dahl, 2007), decreased peripheral vascular resistance (Mannheimer, Emanuelsson, & Waagstein, 1990;Sherry et al, 2001), and heart rate (Nitz, 2003).…”

“…Transcutaneous electrical nerve stimulation (TENS) is a therapeutic modality used primarily in the management of acute and chronic pain (Chesterton, Foster, Wright, Baxter, & Barlas, 2003;Sbruzzi et al, 2012;Vance, Dailey, Rakel, & Sluka, 2014;Bi et al, 2015). The application of this resource comprises the interaction of different parameters, such as intensity, frequency, pulse duration, application time, and positioning of the electrodes (Chesterton et al, 2003).…”