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Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain

PainSci » bibliography » Khadilkar et al 2008
Tags: back pain, TENS, pain problems, spine, devices, treatment

Three articles on PainSci cite Khadilkar 2008: 1. The Complete Guide to Trigger Points & Myofascial Pain2. The Complete Guide to Low Back Pain3. Zapped! Does TENS work for pain?

PainSci commentary on Khadilkar 2008: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a review of just four trials of TENS for chronic low back pain that were good enough to bother reviewing, and even those four were too messy for a good apples-to-apples comparison (meta-analysis). The conclusions is inconclusive, based mainly on conflicting evidence with regards to pain intensity. A previous review (Milne) was more clearly negative.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as a therapeutic adjunct to the pharmacological management of pain. However, despite widespread use, its effectiveness in chronic low-back pain (LBP) is still controversial.

OBJECTIVES: To determine whether TENS is more effective than placebo for the management of chronic LBP.

SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro and CINAHL were searched up to July 19, 2007.

SELECTION CRITERIA: Only randomized controlled clinical trials (RCTs) comparing TENS to placebo in patients with chronic LBP were included.

DATA COLLECTION AND ANALYSIS: Two review authors independently selected the trials, assessed their methodological quality and extracted relevant data. If quantitative meta-analysis was not possible, a qualitative synthesis was performed, taking into consideration 5 levels of evidence as recommended by the Cochrane Collaboration Back Review Group.

MAIN RESULTS: Four high-quality RCTs (585 patients) met the selection criteria. Clinical heterogeneity prevented the use of meta-analysis. Therefore, a qualitative synthesis was completed. There was conflicting evidence about whether TENS was beneficial in reducing back pain intensity and consistent evidence in two trials (410 patients) that it did not improve back-specific functional status. There was moderate evidence that work status and the use of medical services did not change with treatment. Conflicting results were obtained from two studies regarding generic health status, with one study showing no improvement on the modified Sickness Impact Profile and another study showing significant improvements on several, but not all subsections of the SF-36 questionnaire. Multiple physical outcome measures lacked statistically significant improvement relative to placebo. In general, patients treated with acupuncture-like TENS responded similarly to those treated with conventional TENS. However, in two of the trials, an inadequate stimulation intensity was used for acupuncture-like TENS, given that muscle twitching was not induced. Optimal treatment schedules could not be reliably determined based on the available data. Adverse effects included minor skin irritation at the site of electrode placement.

AUTHORS' CONCLUSIONS: At this time, the evidence from the small number of placebo-controlled trials does not support the use of TENS in the routine management of chronic LBP. Further research is encouraged.

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