Categories
Change Password!
Reset Password!
Chronic low back pain (CLBP) is a common cause of persistent pain and disability, and transcutaneous electrical nerve stimulation (TENS) is frequently used as a non-pharmacological treatment option.
Appropriately dosed TENS improves chronic low back pain, with stimulation intensity emerging as the key treatment parameter.
Chronic low back pain (CLBP) is a common cause of persistent pain and disability, and transcutaneous electrical nerve stimulation (TENS) is frequently used as a non-pharmacological treatment option. However, evidence regarding its potency remains inconsistent. Differences in TENS dosing parameters may partly explain these conflicting findings. This systematic review and meta-analysis therefore evaluated the analgesic effects of TENS in CLBP and examined whether treatment parameters, particularly stimulation intensity, impact pain outcomes.
PubMed, Cochrane, and Scopus databases were searched, with 1,162 records screened and 29 studies included in the final analysis. Methodological quality and risk of bias were checked via the Physiotherapy Evidence Database (PEDro) scale and Risk of Bias 2 (RoB 2) tool. Random-effects and mixed-effects models were used to determine the overall effect of TENS and determine whether stimulation parameters modified treatment outcomes.
The initial random-effects analysis found no noticeable overall effect of TENS on pain when dosing parameters were not considered (d+ = 0.16; k = 64). However, treatment intensity considerably influenced the analgesic effect. Appropriate stimulation intensity produced a substantially greater effect than inappropriate intensity (Δd+ ≈ 0.67).
No substantial effect was noted for stimulation frequency, number of sessions, or electrode placement. The analysis supports using TENS at a clearly perceptible sensory-level intensity, with intensity titrated throughout the treatment session. Conversely, fixed stimulation intensity and stimulation strong enough to produce muscle contractions are usually not advocated.
TENS can offer pain alleviation in CLBP when delivered at an appropriately titrated sensory-level intensity, suggesting that treatment dose may help explain the variable potency reported in previous studies. However, the certainty of evidence remains low because of substantial heterogeneity and a high risk of bias. Standardized reporting and optimization of TENS parameters may improve both clinical application and future research.
The European Journal of Pain
Dose–Response Effects of Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain: A Systematic Review and Meta‐Analysis
Juan J Amer‐Cuenca et al.
Comments (0)