Efficacy of TENS in lob back pain

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CLINICAL PAIN MEDICINE

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ISSUE: FEBRUARY, 2010  |  VOLUME: 8:02 printer friendly  |   email this

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Efficacy of TENS Found Wanting for Chronic Low Back Pain 

 

Rosemary Frei

A recent systematic literature review of the use of transcutaneous electric

nerve stimulation (TENS) for pain in neurologic disorders has concluded the

modality does not work for chronic low back pain (Neurology 2009, Dec. 30; Epub

ahead of print). The results—which were published in the form of recommendations

from the American Academy of Neurology’s Therapeutics and Technology Assessment

Subcommittee—add support to those who challenge the value of the FDA-approved

and widely used treatment.

 

“For the FDA to approve a device, the manufacturer [only] has to prove that the

device is as safe as what is currently used. [in contrast,] for a drug or

biological, the manufacturer has to prove efficacy,” noted lead investigator

Richard Dubinsky, MD, MPH, professor and program director, Department of

Neurology, University of Kansas Medical Center, Kansas City. “In our systematic

review of the literature, we found class 1 evidence that TENS does not work for

chronic low back pain, leading to a level A recommendation that TENS not be used

for chronic low back pain.”

 

He added that the review confirmed that TENS works for diabetic neuropathy.

 

In an editorial accompanying the review, Andreas Binder, MD, and Ralf Baron, MD,

defend the status quo. They stated that although the new review is valuable,

there is “considerable empirical evidence” that, at least in some patients, TENS

is useful—and hence its continued inclusion in treatment guidelines is

warranted.

 

“Taking the favorable benefit–risk ratio when [comparing TENS] with other

pain-relieving methods into account, TENS remains a valuable part [of] the

armamentarium of pain therapy,” write Drs. Binder and Baron, of the Division of

Neurological Pain Research and Therapy, Department of Neurology,

Christian-Albrechts-Universitat Kiel, Germany.

 

Dr. Dubinsky and Janis Miyasaki, MD, MEd, searched for studies published up to

April 2009 on Medline or in the Cochrane Library. The review included nine

trials that compared TENS with placebo or another therapy in at least 11 people

who had well-defined painful neurologic disorders.

 

Two class I studies compared TENS with TENS-sham for low back pain for either

four or six weeks. Neither study showed a benefit from TENS treatment, as gauged

by score on a visual analog scale (VAS) or other outcome measures.

 

Three class II studies examined TENS for low back pain. One of these studies

used three different TENS modalities. The majority of patients with

frequency-modulated TENS reported a reduction in pain, whereas most of those

with TENS-burst and conventional TENS did not. One patient did not benefit from

any of the three TENS modalities. The second study showed a modest reduction in

pain intensity on a VAS but no reduction in pain unpleasantness after one and 10

weeks of therapy. The third class II study did not find any significant

differences between TENS and TENS-sham in people with multiple sclerosis and low

back pain.

 

Drs. Dubinsky and Miyasaki also found two class II studies that compared TENS

with TENS-sham, and one class III study comparing TENS with high-frequency

muscle stimulation for pain associated with mild diabetic peripheral neuropathy.

The class II studies pointed to a modest reduction in pain with TENS compared

with TENS-sham, although the class III studies revealed that more patients felt

a benefit from high-frequency muscle stimulation than from TENS.

 

The researchers felt TENS research needed to be bolstered in the following ways:

 

Studies should be performed on TENS-naïve subjects;

The optimal paradigm for use of TENS in alleviating pain associated with

neurologic disorders should be determined and then applied to those disorders;

Subsequent studies should be randomized controlled trials comparing chronic TENS

with chronic TENS-sham.

 

 

 

--

Anyone can sympathize with the sufferings of a friend, but it requires a very

fine nature to sympathize with a friend's success.

Oscar Wilde