ArticleLiterature Review

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

February 2008
Cochrane Database of Systematic Reviews 4(4):CD003008

February 2008
4(4):CD003008

DOI:10.1002/14651858.CD003008.pub3

Source
PubMed

Authors:

Amole Khadilkar

Health Canada

Daniel Oluwafemi Odebiyi

University of Lagos

Lucie Brosseau

University of Ottawa

George Wells

University of Ottawa

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.

Comparison of the efficacy of continuous radiofrequency thermocoagulation, pulsed radiofrequency denervation applications, and TENS therapies for lumbar facet syndrome: A single-blind randomized controlled trial

Article

Jan 2024

Objectives: We aimed to compare the effectiveness of TENS, used in physical therapy departments, and continuous radiofrequency thermocoagulation (CRF) and pulsed radiofrequency denervation (PRF), used in algology departments, in patients with lumbar facet syndrome (LFS). Methods: Subjects were selected from patients with LFS visiting outpatient clinics of physical therapy and algology departments at Ege University School of Medicine, whose pain was refractory to medical treatment for at least 3 months. Subjects were randomized into 3 groups. A total of 60 patients, with 20 in each group, were enrolled. The first group received CRF, the second group received TENS for 30 minutes a day for 15 days, and the third group received PRF. Patients were assessed at baseline, at the end of the first and sixth months, for a total of three times. Results: Improvements at month 1 and month 6 were found to be statistically significant in all three treatment groups with respect to their pain scores, Oswestry Disability Indexes, hand-floor distance measurements, 20-meter walking times, 6-min walking distances, Beck Depression Inventory, and most of the SF-36 domain scores (p<0.05). A comparison of the treatment groups showed no superiority of any group over the others in any assessment parameters (p>0.05). Conclusion: We suggest that it might be more appropriate to use TENS, a non-invasive treatment, before trying more invasive procedures like CRF and PRF in these patients. However, it has been stated that further studies involving a larger patient sample are needed.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Primary Low Back Pain in Adults

Article

Full-text available

Nov 2023
J OCCUP REHABIL

Purpose To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. Eligible RCTs targeted TENS compared to placebo/sham, usual care, no intervention, or interventions with isolated TENS effects (i.e., combined TENS with treatment B versus treatment B alone) in adults with CPLBP. We extracted outcomes requested by the WHO Guideline Development Group, appraised the risk of bias, conducted meta-analyses where appropriate, and graded the certainty of evidence using GRADE. Results Seventeen RCTs (adults, n = 1027; adults ≥ 60 years, n = 28) out of 2010 records and 89 full text RCTs screened were included. The evidence suggested that TENS resulted in a marginal reduction in pain compared to sham (9 RCTs) in the immediate term (2 weeks) (mean difference (MD) = -0.90, 95% confidence interval -1.54 to -0.26), and a reduction in pain catastrophizing in the short term (3 months) with TENS versus no intervention or interventions with TENS specific effects (1 RCT) (MD = -11.20, 95% CI -17.88 to -3.52). For other outcomes, little or no difference was found between TENS and the comparison interventions. The certainty of the evidence for all outcomes was very low. Conclusions Based on very low certainty evidence, TENS resulted in brief and marginal reductions in pain (not deemed clinically important) and a short-term reduction in pain catastrophizing in adults with CPLBP, while little to no differences were found for other outcomes.

Immediate analgesic effect of two modes of transcutaneous electrical nerve stimulation on patients with chronic low back pain: a randomized controlled trial

Article

Full-text available

Dec 2021

Objective: To compare and assess the immediate analgesic effects of conventional and burst transcutaneous electrical nerve stimulation in patients with chronic low back pain. Methods: We conducted a three-arm single-blinded randomized controlled trial. A total of 105 patients with non-specific chronic low back pain aged between 18 and 85 years were randomly assigned into the following groups: Placebo Group (sham electrical stimulation), Conventional TENS Group (continuous stimulation at 100Hz for 100µs with sensory intensity), and Burst TENS Group (stimulation at 100Hz modulated at 2Hz for 100µs with motor-level intensity). All groups received a single application of transcutaneous electrical nerve stimulation for 30 minutes. The outcomes, namely, pain intensity, quality of pain, and pressure pain threshold were measured by the visual analog scale, McGill pain questionnaire, and algometry, respectively. The patients were evaluated before and immediately after the transcutaneous electrical nerve stimulation application. Results: Pain intensity (visual analog scale score) and quality of pain (McGill pain questionnaire score) significantly decreased (p<0.05) in Intervention Groups (Conventional TENS Group and Burst TENS Group). A positive effect was observed in the interventions compared to the Placebo Group in all domains of the McGill pain questionnaire (p<0.05), excepting for the pain intensity. Pressure pain threshold significantly increased (p<0.05) immediately after the transcutaneous electrical nerve stimulation application in both Intervention Groups, but not in the Placebo Group. For significant difference was found during assessment when comparing both Intervetion Group. Conclusion: Both transcutaneous electrical nerve stimulation modes were effective for pain modulation. Moreover, there was an increase in the pressure pain threshold. No significant results were found to indicate the best mode for the treatment of chronic low back pain.Clinical Trial Registration: RBR-59YGRB.

High-Frequency Impulse Therapy for Treatment of Chronic Back Pain: A Multicenter Randomized Controlled Pilot Study

Article

Full-text available

Sep 2021

Purpose: This study aims to examine high-frequency impulse therapy (HFIT) impact on pain and function among patients undergoing care for chronic low back pain (CLBP). Methods: A pilot randomized-controlled trial of HFIT system versus sham was conducted across 5 orthopedic and pain center sites in California, USA. Thirty-six patients seeking clinical care for CLBP were randomized. Primary outcome was function measured by the Six Minute Walk Test (6MWT). Secondary outcomes were function (Timed Up and Go [TUG] and Oswestry Disability Index [ODI]), pain (Numerical Rating Scale [NRS]), quality of life (Patient Global Impression of Change [PGIC]), and device use. Patients were assessed at baseline and every week for 4 weeks of follow-up. Mann-Whitney U-test was used to analyze changes in each outcome. Repeated measures ANOVA was used to assess the effect of treatment over time. Results: The average age of subjects was 53.9 ± 15.7 (mean ± SD) years, with 12.1 ± 8.8 years of chronic low back pain. Patients who received an HFIT device had a significantly higher 6MWT score at weeks 2 [Cohen's d (95% CI): 0.33 (0.02, 0.61)], 3 [0.32 (0.01, 0.59)] and 4 [0.31 (0.01, 0.60)], respectively, as compared to their baseline scores (p < 0.05). Patients in the treatment group had significantly lower TUG scores at week 3 [0.30 (0.04, 0.57)] and significantly lower NRS scores at weeks 2 [0.34 (0.02, 0.58)] and 4 [0.41 (0.10, 0.67)] (p < 0.05). Conclusion: A larger-scale RCT can build on the findings of this study to test whether HFIT is effective in reducing pain and improving function in CLBP patients. This study shows encouraging evidence of functional improvement and reduction in pain in subjects who used HFIT. The efficacy and minimally invasive nature of HFIT is anticipated to substantially improve the management of CLBP patients.

Die Größe der Placebo-Effekte in klinischen Studien: Konsequenzen für die Praxis: Hannu Luomajoki, Rita Morf, Thomas Weiß

Article

Dec 2023

Zahlreiche Studien zu Placebo-Operationen bei Patient*innen mit Beschwerden im Bereich des Knies, der Schulter und des Rückens verdeutlichen, dass die Resultate ebenso positiv ausfallen wie bei „echten" operativen Maßnahmen. Die wissenschaftliche Evidenz belegt auch, dass manche Schmerzmedikamente nicht effektiver sind als Placebo-Analgetika. Selbst in der Physiotherapie zeigen sich Placebo-Effekte. Es ist wichtig zu betonen, dass diese Effekte moralisch nicht verwerflich sind. Im Gegenteil: Sie können gezielt genutzt werden, um therapeutische Fortschritte zu erzielen.

Systematic Review Procedures for the World Health Organization (WHO) Evidence Syntheses on Benefits and Harms of Structured and Standardized Education/Advice, Structured Exercise Programs, Transcutaneous Electrical Nerve Stimulation (TENS), and Needling Therapies for the Management of Chronic Low Back Pain in Adults

Article

Full-text available

Nov 2023
J OCCUP REHABIL

As commissioned by the WHO, we updated and expanded the scope of four systematic reviews to inform its (in development) clinical practice guideline for the management of CPLBP in adults, including older adults. Methodological details and results of each review are described in the respective articles in this series. In the last article of this series, we discuss methodological considerations, clinical implications and recommendations for future research.

From pulse width modulated TENS to cortical modulation: based on EEG functional connectivity analysis

Article

Full-text available

Aug 2023

Modulation in the temporal pattern of transcutaneous electrical nerve stimulation (TENS), such as Pulse width modulated (PWM), has been considered a new dimension in pain and neurorehabilitation therapy. Recently, the potentials of PWM TENS have been studied on sensory profiles and corticospinal activity. However, the underlying mechanism of PWM TENS on cortical network which might lead to pain alleviation is not yet investigated. Therefore, we recorded cortical activity using electroencephalography (EEG) from 12 healthy subjects and assessed the alternation of the functional connectivity at the cortex level up to an hour following the PWM TENS and compared that with the effect of conventional TENS. The connectivity between eight brain regions involved in sensory and pain processing was calculated based on phase lag index and spearman correlation. The alteration in segregation and integration of information in the network were investigated using graph theory. The proposed analysis discovered several statistically significant network changes between PWM TENS and conventional TENS, such as increased local strength and efficiency of the network in high gamma-band in primary and secondary somatosensory sources one hour following stimulation. Our findings regarding the long-lasting desired effects of PWM TENS support its potential as a therapeutic intervention in clinical research.

The Effect of Transcutaneous Electrical Nerve Stimulation in Low Back Pain: A Narrative Review

Article

Full-text available

Feb 2023

Background: Low back pain (LBP) is a common musculoskeletal disorder in various parts of the world. Pain due to LBP causes a decrease in the quality of life and individual productivity. Pharmacological therapy that causes many side effects is felt, causing non-pharmacological therapeutic approaches to be needed, one of which is TENS, providing a positive impact with minimal side effects. Objective: This study aims to examine the effect of TENS on pain due to LBP. Method: The approach taken is a narrative review by identifying articles in PubMed, CINAHL, and Scopus from 2017-2022 using keywords: low back pain, TENS, pain level, chronic pain. Result: As a result, five articles with RCT studies were included in the analysis. TENS showed a positive effect on reducing pain compared to other interventions, but it was temporary. Although TENS can be used for pain management of LBP, the evidence for its effectiveness is still being studied. Conclusion: TENS can be an alternative therapy that can reduce pain in LBP patients. There are different TENS settings, but all show positive results. The combination of TENS with other therapies can improve better pain reduction results. Recommendation: Research on the effect of TENS on chronic and acute LBP patients needs to be carried out to test the efficacy of TENS on LBP.

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

Article

Full-text available

Oct 2021

Background and Objectives: Uncertainty about the clinical efficacy of transcutaneous electric nerve stimulation (TENS) to alleviate pain spans half a century. There has been no attempt to synthesise the entire body of systematic review evidence. The aim of this comprehensive review was to critically appraise the characteristics and outcomes of systematic reviews evaluating the clinical efficacy of TENS for any type of acute and chronic pain in adults. Materials and Methods: We searched electronic databases for full reports of systematic reviews of studies, overviews of systematic reviews, and hybrid reviews that evaluated the efficacy of TENS for any type of clinical pain in adults. We screened reports against eligibility criteria and extracted data related to the characteristics and outcomes of the review, including effect size estimates. We conducted a descriptive analysis of extracted data. Results: We included 169 reviews consisting of eight overviews, seven hybrid reviews and 154 systematic reviews with 49 meta-analyses. A tally of authors’ conclusions found a tendency toward benefits from TENS in 69/169 reviews, no benefits in 13/169 reviews, and inconclusive evidence in 87/169 reviews. Only three meta-analyses pooled sufficient data to have confidence in the effect size estimate (i.e., pooled analysis of >500 events). Lower pain intensity was found during TENS compared with control for chronic musculoskeletal pain and labour pain, and lower analgesic consumption was found post-surgery during TENS. The appraisal revealed repeated shortcomings in RCTs that have hindered confident judgements about efficacy, resulting in stagnation of evidence. Conclusions: Our appraisal reveals examples of meta-analyses with ‘sufficient data’ demonstrating benefit. There were no examples of meta-analyses with ‘sufficient data’ demonstrating no benefit. Therefore, we recommend that TENS should be considered as a treatment option. The considerable quantity of reviews with ‘insufficient data’ and meaningless findings have clouded the issue of efficacy. We offer solutions to these issues going forward.

‘What should we teach?’ A U.K. survey comparing clinician and academic views on content of the pre-registration musculoskeletal physiotherapy curriculum

Article

Full-text available

Nov 2023

Evolving evidence underpinning musculoskeletal physiotherapy challenges the definitions of contemporary clinical practice and pre-registration curricula. This research uses an online national survey to compare clinician (272) and lecturer (61) views on the Chartered Society of Physiotherapy’s four pillars of practice (manual therapy and therapeutic handling; exercise, movement, and rehabilitation; therapeutic and diagnostics technologies; and allied approaches, including psychologically informed approaches) with the aim of establishing their clinical and educational utility. Findings indicate that close alignment exists between practising U.K. musculoskeletal physiotherapists and U.K. pre-registration physiotherapy lecturers on the ongoing relevance of exercise therapy and psychologically informed approaches to behaviour change. The paper also shows that a mismatch exists in the clinical and educational use of both manual therapy and electrotherapy between practising physiotherapists and physiotherapy lecturers. Future research should focus on the highlighted need to continue to align pre-registration musculoskeletal curricula with both the evidence base and clinical practice for the curricular areas of electrotherapy and manual therapy. This article was published open access under a CC BY licence: https://creativecommons.org/licences/by/4.0 .

Efficacy of a conservative physical treatment regimen on psychological status and quality of life in Greek patients with chronic low back pain

Article

Full-text available

Mar 2024

Chronic Low Back Pain (CLBP) is a very common health problem that has a great negative impact on the quality of life and the psychological well-being of backache patients. Literature findings have shown that a conventional physiotherapeutic approach is a beneficial choice for CLBP management. The aim of this study was to examine the short-term effects of a conservative physical treatment on depression, anxiety, somatic symptom disorders (SSD), quality of life, pain and disability in Greek individuals suffering from CLBP. Seventy-five CLBP patients were recruited using random systematic sampling. All subjects received ultrasound, low-level laser, massage, transcutaneous electrical nerve stimulation (ΤENS) and alongside an exercise program (sum of 10 sessions, 5 times per week). The intervention was assessed by comparing pre and post outcome measurements based on the Hospital Anxiety and Depression Scale (HADS), Somatic Symptom Scale-8 (SSS-8), EuroQol 5-dimension 5-level (EQ-5D-5L), Roland-Morris Disability Questionnaire (RMDQ) and Pain Numerical Rating Scale (PNRS) instruments. The mean age of the sample was 60.8 years (±14.4) and nearly one out of four (25.3%) was obese. After the end of the treatment, there were improvements in EQ-5D-5L indices and decreases in HADS, SSS-8, RMDQ and PNRS scores, which were found to be statistically significant. Greater effect size was found in PNRS (d=0.75), followed by EQ-5D-5L index value scale (d=0.42), SSS-8 (d=0.38), EQ-5D-5L VAS (d=0.36), RMDQ (d=0.29), HADS-A (d=0.16) and HADS-D (d=0.14). Men and women had similar changes in all under-study scales after the treatment, while besides pain scale, the pre-intervention scores as well as the degree of change in all scores were similar across all Body Mass Index (BMI) levels. In conclusion, convectional physical treatment was found to be an effective option in improving considerably the psychological status and quality of life, while also decreasing functional disability and pain in CLBP patients in the short run.

Effects of Transcutaneous Electrical Nerve Stimulation (TENS) on Chronic Pain in Older Adults: a Systematic Review and Meta‑Analysis

Article

Full-text available

Apr 2023

Purpose of Review This study is aimed to systematically review the effectiveness of transcutaneous electrical nerve stimulation (TENS) in the management of chronic musculoskeletal pain in older adults. Recent Findings While there is no certain method of pain management for older adults, recent developments in electrical stimulation have received attention. The effectiveness of TENS on pain management, quality of life, and concurrent therapy including pharmaceuticals among the older population has generated controversy in the current literature. Summary Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020, PubMed, Web of Science, Embase, and Scopus databases were searched comprehensively from inception to March 2022. Randomized controlled trials regarding the application of TENS in managing chronic, musculoskeletal pain (> 3 months) among adults aged older than 50 years were included. Two independent reviewers extracted the main data from eligible studies. The methodological quality of the studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. Meta-analysis was performed using Review Manager (RevMan) software v5.4. From a total of 2049 citations, 11 randomized controlled trials (RCTs) were eligible for entering this study. Meta-analysis showed that TENS led to a significant improvement in Visual Analogue Score (VAS) (SMD = 1.54, 95% CI = [1.10 to 1.98], p < 0.00001). In addition, disability score was decreased measured by the Roland-Morris Disability (RMD) score (SMD = 1.11, 95% CI = [0.48 to 1.74], p = 0.0005) and Numeric Rating Scale (NRS) (SMD = 1.34, 95% CI = [0.74 to 1.94], p < 0.0001). This systematic review and meta-analysis provides level III evidence that TENS can have a promising effect on improving chronic pain in older individuals. However, due to the heterogeneity among the included studies, these results should be generalized cautiously.

Comparison of diadynamic current, interferential current and transcutaneous electrical nerve stimulation therapies in patients with chronic low back pain

Article

Oct 2022

Alteration in Cortical Activity and Perceived Sensation Following Modulated TENS

Article

Full-text available

Jan 2023

Over the last decades, conventional transcutaneous electrical nerve stimulation (TENS) has been utilized as an efficient rehabilitation intervention for alleviation of chronic pain, including phantom limb pain (PLP). However, recently the literature has increasingly focused on alternative temporal stimulation patterns such as pulse width modulation (PWM). While the effect of non-modulated high frequency (NMHF) TENS on somatosensory (SI) cortex activity and sensory perception has been studied, the possible alteration following PWM TENS at the SI has not yet been explored. Therefore, we investigated the cortical modulation by PWM TENS for the first time and conducted a comparative analysis with the conventional TENS pattern. We recorded sensory evoked potentials (SEP) from 14 healthy subjects before, immediately, and 60 min after TENS interventions (PWM and NMHF). The results revealed suppression of SEP components, theta, and alpha band power simultaneously associated with the perceived intensity reduction when the single sensory pulses applied ipsilaterally to the TENS side. The reduction of N1 amplitude, theta, and alpha band activity occurred immediately after both patterns remained at least 60 min. However, the P2 wave was suppressed right after PWM TENS, while NMHF could not induce significant reduction immediately after the intervention phase. As such, since PLP relief has been shown to be correlated with inhibition at somatosensory cortex, we, therefore, believe that the result of this study provides further evidence that PWM TENS may also be potential therapeutic intervention for PLP reduction. Future studies on PLP patients with PWM TENS sessions is needed to validate our result.

The effect of transcutaneous electrical nerve stimulation on pain and electrical stimulation muscle thickness in patients with Non-specific Chronic Low Back Pain-based ultrasonographic evaluation

Article

Jan 2023

Aim: The existing mechanisms of transcutaneous electrical nerve stimulation (TENS) focuses more on the effect of neural tissue. This study investigated the effect of TENS on the thickness of the erector spinae muscles and reducing pain. Patients & methods: 56 individuals with low back pain participated in this single-blind, pre-posttest study. For two weeks, participants underwent ten sessions of TENS. The ultrasound evaluations examined the thickness of the erector spinae muscle, and the visual analog scale measured the severity of low back pain. Results: There was a decrease in pain score and muscle thickness after the interventions (p ≤ 0.004). There was also a strong correlation between reducing pain and decreasing muscle thickness (R = 0.709; p = 0.000). Conclusion: Following TENS in the lumbar, in addition to reducing pain, the thickness of the erector spinae muscles also decreased. Clinical Trial Registration: IRCT20200423047173N1 ( ClinicalTrials.gov )

Pain management by alternative therapies and herbal bioactive

Article

Full-text available

Dec 2022

Herbal medicines and other complementary & alternative therapies are now a part of the mainstream healthcare system. Adults frequently utilizing herbal remedies to treat pain, which is one of the most prevalent ailments. Although herbal remedies are frequently not the most effective analgesics in the market, they can be very helpful for mild to moderate pain. Herbal bioactive substances may reduce the effectiveness of conventional treatments for pain. Life quality suffers, and excessive medical costs rise as a result of pain. Western medicine may have too many negative effects, such as addiction and tolerance. Alternative pain-management approaches may be offered by herbal medicines. Neuropathic pain is one of the many types of chronic pain that results from damage to the neurological system, including the peripheral nerves. There are few treatments for neuropathic pain now available. Recent studies have also shown the value of dietary bioactive compounds in the management of pain like Ginger, Curcumin, Omega-3 polyunsaturated fatty acids, soy isoflavones and Lycopene. The goal of this review paper is to determine the function of various bioactive and some traditional alternative therapies in the treatment of pain.

A Review of Chronic Pain and Device Interventions: Benefits and Future Directions

Article

Full-text available

Dec 2022

Chronic pain is a debilitating condition with a growing prevalence both in the USA and globally. The complex nature of this condition necessitates a multimodal approach to pain management that extends beyond the established pharmaceutical interventions currently employed. A variety of devices comprising both invasive and noninvasive approaches are available to patients, serving as adjuvants to existing regimens. The benefits of these interventions are notable for their lack of addiction potential, potential for patient autonomy regarding self-administration, minimal to no drug interaction, and overall relative safety. However, there remains a need for further research and more robust clinical trials to assess the true efficacy of these interventions and elucidate if there is an underlying physiological mechanism to their benefit in treating chronic pain or if their effect is predominantly placebo in nature. Regardless, the field of device-based intervention and treatment remains an evolving field with much promise for the future chronic pain management.

Effects of an Impulse on the Sterno-Cleido-Mastoid Muscle on Back Pain, Discomfort, and Well-Being: A Randomized Controlled Trial in People with Low Back Pain

Article

Full-text available

Sep 2022

Introduction: In the treatment of low back pain (LBP), passive regimens (e.g., relaxation) as opposed to active regimens (e.g., muscle training) may be a useful adjunct or, in certain cases, the only possible approach. Passive relaxation may be particularly useful for individuals who have lost the ability to adequately perceive relaxed muscles. The aim of the randomized controlled trial presented here was to investigate a specific and novel treatment for passive relaxation, namely the Vitametik Impulse (VI). Methods: Participants (n = 135; 73.3 % women; 26.7 % men) were individuals with mild to moderate LBP aged from 19 to 76 years (M = 48.8). The participants were randomly assigned to one of four different groups (three different 8-week interventions, one control group). Pain, discomfort, and well-being were measured before and after the intervention period and at an 8-week follow-up. Results: In the VI group the decrease in various pain variables and discomfort was higher compared to the control group and compared to an educational program (EP). There were no differences between the VI group and a combined VI/EP group. The effects remained stable until follow-up. Conclusion: VI appears to be an effective approach in the treatment of LBP, although the underlying mechanism remains unproven. Future studies should compare VI treatment with specific relaxation techniques or active muscle training. In addition, the results of the study need to be replicated. Trial registry ID: DRKS00026270 (German Clinical Trials Registry).

Non-operative treatment for low back pain: A review of evidence and recommendations

Article

Full-text available

Aug 2022
NATL MED J INDIA

Background Low back pain (LBP) is a healthcare problem with high global prevalence, with non-operative management being the first line of treatment in the majority of patients. This literature review summarizes the current evidence for various modalities of non-operative treatment for LBP. Methods We did a literature search to elicit high-quality evidence for non-operative treatment modalities for LBP, including Cochrane Database reviews and systematic reviews or meta-analysis of randomized controlled trials. Only when these were not available for a particular treatment modality, other level 1 studies were included. The quality of evidence was categorized in accordance with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method—a globally adopted tool for grading the quality of evidence and making treatment recommendations. Results The treatment modalities that were reviewed included: general measures, medications/pharmacotherapy, exercises, electromagnetic therapies, alternative treatment modalities and interventional therapies. We found that high-quality evidence is lacking for most non-operative treatment modalities for LBP. The majority of interventions have small benefits or are similar to placebo. Conclusion The current evidence for non-operative treatment modalities for LBP is insufficient to draw conclusions or make recommendations to clinicians. High-quality trials are required before widespread use of any treatment modality. Considering that non-operative treatment is usually the first line of therapy for most patients with LBP, it deserves to be the focus of future research in spinal disorders.

Movement Analysis Could Help in the Assessment of Chronic Low Back Pain Patients: Results from a Preliminary Explorative Study

Article

Full-text available

Jul 2022
Int J Environ Res Publ Health

This study aimed to assess the reliability of a qualitative scoring system based on the movement analysis of the spine in different populations and after usual care rehabilitative intervention. If proven true, the results could further future research development in quantitative indexes, leading to a possible subclassification of chronic low back pain (cLBP). Methods: This was a preliminary exploratory observational study. Data of an optoelectronic spine movement analysis from a pathological population (cLBP population, 5 male, 5 female, age 58 ± 16 years) were compared to young healthy participants (5M, 5F, age 22 ± 1) and were analysed via a new qualitative score of the pattern of movement. Internal consistency was calculated. Two independent assessors (experienced and inexperienced) assessed the blinded data, and we calculated inter- and intrarater reliability. We performed an analysis for cLBP pre and post a ten session group rehabilitation program between and within groups. Results: Internal consistency was good for all movements (α = 0.84–0.88). Intra-rater reliability (Intraclass correlation coefficient–ICC) was excellent for overall scores of all movements (ICC(1,k) = 0.95–0.99), while inter-rater reliability was poor to moderate (ICC(1,k) = 0.39–0.78). We found a significant difference in the total movement scores between cLBP and healthy participants (p = 0.001). Within-group comparison (cLBP) showed no significant difference in the total movement score in pre and post-treatment. Conclusion: The perception of differences between normal and pathological movements has been confirmed through the proposed scoring system, which proved to be able to distinguish different populations. This study has many limitations, but these results show that movement analysis could be a useful tool and open the door to quantifying the identified parameters through future studies.

Interventional Pain Management and Chronic Low Back Pain: Effectiveness and Patient Outcomes

Article

Full-text available

Mar 2022

Anthony Davies

Low back pain is widespread in the general population and practice. Chronic back pain is defined as pain lasting more than 3-6 months. This literature review project will examine the question: In adult patients suffering from chronic back pain, is interventional pain management as good as or better than standard pain management in improving patient-oriented outcomes including safety and tolerability, years lived with disability, reduction in pain, improvement in functional outcome and social participation, and cost-effectiveness? The method used will involve searching the published and grey literature for high-quality systematic reviews, meta-analyses, randomized controlled trials and clinical practice guidelines in the subject with a view to critically appraise the evidence by analyzing intention to treat, the number needed to treat/harm, absolute risk reduction and relative risk reduction. The author hopes to synthesize knowledge in this well-studied area to present standard interventional techniques and their relative effectiveness in chronic back pain to consistently achieve the most common outcomes of importance to patients identified in the literature.

Evaluation of Lumbar Myofascial Release Effects on Lumbar Flexion Angle and Pelvic Inclination Angle in Patients with Non-Specific Low Back Pain

Article

Full-text available

Mar 2022

Background: Many studies have shown that changes in lumbar flexion angle and the pelvic inclination angle can be affected by the shortening of the lumbar muscles, which can cause low back pain. Decreased lumbar flexion angle and pelvic inclination angle can cause or exacerbate low back pain by disrupting the lumbo-pelvic rhythm. Purpose: This study aimed to use myofascial release techniques as a specialized treatment on muscle tissue to cause muscles to reach the optimal length and improve lumbar flexion angle and pelvic inclination angle, and thus improve low-back pain. Setting: Non-specific low back pain patients, Tarbiat Modares University, Iran. Participants: 30 chronic non-specific low back pain participants were randomly assigned into two groups. Research design: This is a randomized control trial. Interventions: The myofascial release group (n=15) underwent 4 sessions of myofascial release treatment based on Myer's techniques, and the control group (n=15) underwent 10 sessions of routine electrotherapy for two weeks. Main outcome measures: Before starting the intervention and after the last treatment session, both groups were evaluated by the lumbar flexion angle with a flexible ruler, calculating the pelvic inclination angle by a trigonometric formula, and VAS measured the pain score of the participants. Results: The results of the paired t test showed that, after treatment in both groups, the severity of pain and lumbar flexion angle changed significantly (p ≤ .001). However, the pelvic inclination angle was changed considerably only in the myofascial release group, and we did not see significant changes in the control group (p = .082). Also, the independent sample t test results to examine the between-group changes showed that changes in the myofascial release group were significantly different from the control group (p ≤ .000). Also, the effect size shows the large effect of the myofascial release technique compared to the control group (effect size ≥ 1.85). Conclusion: The present study results showed that myofascial release techniques in patients with low back pain could help decrease pain intensity and increase lumbar flexion and pelvic inclination angle. Based on the present study results, myofascial release can be a treatment to correct posture in patients with chronic non-specific, low back pain. Due to the prevalence of the COVID-19 pandemic, it was not possible to evaluate the long-term effects of treatment.

Transcutaneous electrical nerve stimulation effects on pain-intensity and endogenous opioids levels among chronic low-back pain patients: A randomised controlled trial

Article

Full-text available

Feb 2022
J BACK MUSCULOSKELET

Background: Transcutaneous electrical nerve stimulation (TENS) is a promising non-pharmacological modality for the management ofchronic low back pain (CLBP), but its efficacy and mode of action have not been clearly established. Objective: To evaluate the responses of plasma beta-endorphin (βE), met-enkephalin (ME), and pain intensity (PI) among patients with CLBP exposed to TENS or sham-TENS. Methods: This double-blind trial involved 62 participants (aged 53.29 ± 5.07 years) randomised into TENS group (frequency 100 Hz, burst-rate 2 Hz, burst-width 150 μs, intensity 40 mA, duration 30 min), and sham-TENS group. The PI and plasma concentrations of βE and ME were measured at baseline, immediately (0 hr), 1 hr, 24 hrs, and 48 hrs post-intervention. Data were analysed using general linear model repeated measures, ordinal regression, one-way analysis of variance, Kruskal-Wallis test, independent and paired t-tests, Mann-Whitney U test, Wilcoxon signed-rank test, and Kendall's tau coefficient. Results: There was a significant temporal difference in PI between groups, F (1, 58) = 18.83, p< 0.001; the TENS group had better pain relief. The relative analgesic effect of TENS started immediately after the intervention (median difference [M⁢D] =-3, p< 0.001), peaked at 1 hr (M⁢D=-4, p< 0.001), and worn out by 24 hrs (M⁢D=-1, p= 0.029). However, there was no significant difference in βE and ME between the groups from 0 hr to 24 hrs post interventions, and no significant correlation between the PI, and βE, or ME. Conclusion: TENS significantly reduced PI up to 24 hrs after treatment.

Foundational Research Could Improve Future Transcutaneous Electrical Nerve Stimulation Evaluations

Article

Full-text available

Jan 2022

Background and objectives: There is a lack of good quality evidence regarding the effectiveness of transcutaneous electrical nerve stimulation (TENS) for chronic musculoskeletal pain, including chronic low back pain. High quality randomised controlled trials (RCTs) have been called for to establish effectiveness over and above placebo and some guidance has already been offered regarding the design of such trials. This article expands the discussion regarding the design of future TENS trials. There is qualitative evidence of the complexity of TENS as an intervention which should be considered in future TENS evaluations. This complexity includes multiple benefits reported by patients, depending on their chosen contexts of TENS use. The ideal content and delivery of support for patients to optimise TENS use also lacks consensus. There is no evidence that a TENS education package has been designed to support the complex set of behaviours and choices which experienced users suggest are required to optimise TENS benefits. Finally, clinical and research outcomes have not been contextualised and related to the specific strategies of use. Conclusions: We suggest that research is required to develop consensus about the content and delivery of training in TENS use for patients who live with pain, informed by the experience of patients, clinicians, and researchers. Once a consensus about the content of TENS training has been reached, there is then a need to develop a TENS training course (TTC) based on this content. An effective and acceptable TTC is needed to develop the knowledge and skills required to optimise TENS use, supporting patients to build confidence in using TENS in everyday life situations with the aim of reducing the impact of chronic pain on function and quality of life. Further research is required to extend the evidence base regarding appropriate, contextualised TENS patient-reported outcomes.

Effect of Modulated TENS on Corticospinal Excitability in Healthy Subjects

Article

Full-text available

Jan 2022
NEUROSCIENCE

Conventional transcutaneous electrical nerve stimulation (TENS) has been reported to effectively alleviate chronic pain, including phantom limb pain (PLP). Recently, literature has focused on modulated TENS patterns, such as pulse width modulation (PWM) and burst modulation (BM), as alternatives to conventional, non-modulated (NM) sensory neurostimulation to increase the efficiency of rehabilitation. However, there is still limited knowledge of how these modulated TENS patterns affect corticospinal (CS) and motor cortex activity. Therefore, our aim was to first investigate the effect of modulated TENS patterns on CS activity and corticomotor map in healthy subjects. Motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) were recorded from three muscles before and after the application of TENS interventions. Four different TENS patterns (PWM, BM, NM 40Hz, and NM 100 Hz) were applied. The results revealed significant facilitation of CS excitability following the PWM intervention. We also found an increase in the volume of the motor cortical map following the application of the PWM and NM (40 Hz). Although PLP alleviation has been reported to be associated with an enhancement of corticospinal excitability, the efficiency of the PWM intervention to induce pain alleviation should be validated in a future clinical study in amputees with PLP.

The efficacy of microcurrent electrical nerve stimulation in treating masticatory myofascial pain: A systematic review and meta-analysis

Article

Dec 2021

Objective To assess the efficacy of microcurrent electrical nerve stimulation (MENS) therapy in treating myofascial pain of the masticatory muscles. Methods In this systematic review and meta-analysis, the efficacy of MENS was evaluated, with the primary outcome being the reduction in pain on palpation of the masticatory muscles. Results Four independent comparisons based on three studies were included in the meta-analysis (n = 140). In comparison to placebo and other therapies, treatment with MENS showed an improved mean reduction in pain of −0.57 points (CI: −0.91 to −0.23 points, I² = 83.7%). Conclusion Evidence from this meta-analysis shows that MENS is an effective non-invasive treatment that can be used to reduce pain in patients with myofascial pain of the masticatory muscle; however, the study was limited by the small number of articles relevant to the research question as well as variability between the selected studies.

Functional disorders – new proposals for definition, psychosomatics, somatization

Article

Full-text available

Nov 2021

Slawomir Czachowski

Podsumowanie: Czynnościowe (funkcjonalne) zaburzenia somatyczne są częstymi objawami praktyce klinicznej zarówno w podstawowej jak i specjalistycznej opiece zdrowotnej. Najczęściej występują one w postaci niespecyficznych bólów, zmęczenia, zawrotów głowy lub szumów uszu. Z powodu ich niespecyficznego charakteru i braku skutecznych metod leczenia dolegliwości sprawiają problemy kliniczne. Stanowią również problem w zakresie klasyfikacji i różnych podziałów klinicznych. Pacjenci z tymi objawami wykazują cechy frustracji z powodu nieskutecznego przebiegu leczenia i często negują wpływ sfery psychicznej na pojawiające się dolegliwości. Klinicyści traktują tę grupę jako trudnych pacjentów. Używane modele klasyfikacyjne sprawiają problemy w komunikacji między terapeutami i pacjentami. Obecnie funkcjonują systemy klasyfikacyjne w formie ICD-10, DSM-5. Pozostałe, DCPR-SSI, RDoC są w trakcie intensywnych badań. W poniższym artkule opisano definicję, klasyfikacje i zapowiadaną nową nomenklaturę w ICD-11, która jest przygotowana przez Światową Organizację Zdrowia. Przytoczono również propozycje nowych nazw zespołów chorobowych. Opisano podstawowe koncepcje tłumaczące etiologię zespołów czynnościowych oraz nowe kierunki poszukiwań w obszarze zaburzonych procesów kognitywnych. Na końcu artykułu przytoczono sugestie terapeutyczne w pięciu obszarach oddziaływania leczniczego. Przybliżono najnowsze dane z eksperymentalnych metod stosowanych w neuroterapii w postaci EEG-Neurofeedbacku.

Repetitive transcranial magnetic stimulation in the treatment of chronic low back pain. A systematic review (Part I)

Article

Full-text available

Sep 2021

Цель обзора - анализ результатов исследований эффективности ритмической транскраниальной и трансспинальной магнитной стимуляции (рТМС и рТсМС) в лечении боли в пояснице. Хроническая боль в нижней части спины (ХБНЧС) составляет 22% от всех случаев хронической боли и 35% от рефрактерных болевых синдромов, и осложняется изменчивостью проявлений и механизмов, лежащих в ее основе. Невысокие успехи традиционного лечения и реабилитации пациентов с ХБНЧС не учитывают каскад нейрофизиологических изменений (нейропластичность), включающий в себя сложное взаимодействие между повреждением тканей, изменением афферентной информации, передаваемой от периферических рецепторов к спинному мозгу, стволу и областям коры головного мозга, изменениями в нейронной обработке болевых раздражителей и психосоциальных факторов. Это находит отражение в повышенном интересе профессионального сообщества регенеративной медицины к применению высокотехнологических методов нейромодуляции ритмическими электромагнитными импульсами при ХБНЧС. В настоящей первой части обзора представлен систематический анализ накопленных к моменту его публикации литературных данных, которые подтверждают, что ритмическая транскраниальная магнитная стимуляция (рТМС) является патогенетическим терапевтическим методом для таких пациентов, основываясь на экспериментальных и клинических эффектах положительного влияния на искаженную сенсорную передачу, изменение проприоцепции, управление движением и психологическую модуляцию. Методика зарекомендовала себя в кратковременном облегчении хронической дорсалгии, в то время как долгосрочные последствия рТМС (>3 месяцев) должны быть исследованы далее. Для уточнения ее эффективности у пациентов с ХБНЧС требуется последующий набор продуманных РКИ как по дизайну, так и специфике «ослепления» участников. Кроме того, различные факторы, связанные с унификацией пока еще разнородных протоколов стимуляции, включая форму подачи импульсов, частоту, место приложения, регулярность и продолжительность лечения, могут улучшить дальнейшую надлежащую трактовку ее результатов. The aim of this review was to analyze results of studies on the effectiveness of repetitive transcranial and trans-spinal magnetic stimulation (rTMS and rTsMS) in the treatment of low back pain. Chronic low back pain (CLBP) accounts for 22% of all chronic pain cases and 35% of refractory pain syndromes and is complicated by the variability of its manifestations and mechanisms. The low success rate of traditional treatment and rehabilitation of patients with chronic pain does not take into account the cascade of neurophysiological changes (neuroplasticity), including complex interaction between tissue damage, changes in afferent information transmitted from peripheral receptors to spinal cord, brainstem and cortical regions, changes in neural processing of pain stimuli and psychosocial factors. This is reflected in the increased interest of the professional community of regenerative medicine in implementing high-tech methods of neuromodulation by repetitive electromagnetic pulses in CLBP. This first part of the review presents a systematic analysis of the literature data accumulated by the time of its publication, confirming that repetitive transcranial magnetic stimulation (rTMS) is a viable pathogenetic therapeutic method for such patients, based on experimental and clinical positive effects on impaired sensory transmission, changes in proprioception, motor control, and psychological modulation. The method has proven successful in providing short-term relief for chronic dorsalgia, while the long-term effects of rTMS (>3 months) require further investigation. In order to clarify its efficacy in patients with CLBP, a follow-up set of elaborate RCTs is required, both in terms of design and specific «blinding» of participants. In addition, various factors associated with the unification of the still heterogeneous stimulation protocols, including pulse delivery form, frequency, application location, periodicity and treatment duration, may further improve proper result interpretation.

The effect of head movement restriction on the kinematics of the spine during lifting and lowering tasks

Article

Nov 2021
ERGONOMICS

This study aimed to examine the effects of head movement restriction on relative angles and their derivatives using the stepwise segmentation approach during lifting and lowering tasks. Ten healthy men lifted and lowered a box using two styles (stoop and squat), with two loads (i.e. 10% and 20% of body weight); they performed these tasks with two instructed head postures [(1) Flexing the neck to keep contact between chin and chest over the task cycle; (2) No instruction, free head posture]. The neck flexion significantly affected the flexion angle of all segments of the spine and specifically the lumbar part. Additionally, this posture significantly affected the derivatives of the relative angles and manifested latency in spine segments movement, that is, cephalad-to-caudad or caudad-to-cephalad patterns. Conclusively, neck flexion as an awkward posture could increase the risk of low back pain during lifting and lowering tasks in occupational environments. Practitioner summary: Little information is available about the effects of neck flexion on other spine segments’ kinematics and movement patterns, specifically about the lumbar spine. The result of this experimental study shows that neck flexion can increase the risk of low back pain by increasing lumbar flexion angle and spine awkward posture.

Clinical Medicine Gait Kinetic and Kinematic Changes in Chronic Low Back Pain Patients and the Effect of Manual Therapy: A Randomized Controlled Trial

Article

Full-text available

Aug 2021

Citation: Krekoukias, G.; Sakellari, V.; Anastasiadi, E.; Gioftsos, G.; Dimitriadis, Z.; Soultanis, K.; Gelalis, I.D. Gait Kinetic and Kinematic Changes in Chronic Low Back Pain Patients and the Effect of Manual Therapy: A Randomized Controlled Trial.

Devices for osteoarthritis symptoms treatment: a patent review

Article

Jan 2024
EXPERT REV MED DEVIC

Introduction: Osteoarthritis is a musculoskeletal disease that can lead to the loss and inability of those affected to perform normal daily functions, which leads to a decrease in quality of life. The main symptoms of osteoarthritis are tenderness, joint pain, stiffness, crepitus, limited movement, and local inflammation. Areas covered: The selected patents were deposited from 2010 to April 2022 involving 57 documents that were in line with the study objective in the final selection. The patents were classified in years, country, and applicants. Also, the therapeutic fields that presented the most documents were electrical stimulation, phototherapy, and ultrasound, followed by magnetic, electromagnetic, and thermotherapy. Therefore, the most current therapies used in the documents are already on the market. Expert opinion: Although the OA is cureless, non-surgical treatments are classified as the primary management approach for this disease. The pharmacological and non-pharmacological therapies are employed to reduce its prevalence and ensure the effectiveness of treatments. A strategy for relieving OA symptoms is non-pharmacological treatment, which can be based on exercise and patient education, combined with other alternative therapies. These therapies are used as supplements to the main OA treatments, enhancing the effectiveness of treatment outcomes.

Mindfulness-based Interventions for Chronic Low Back Pain: A Systematic Review and Meta-analysis

Article

Nov 2023
CLIN J PAIN

Objective This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the US each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized. Design Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for, randomized controlled trials (RCTs), pilot RCTs and single-arm studies that explored the effectiveness of MBIs in CLBP. Methods Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7. Results Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included Mindfulness Meditation, Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Mindfulness Oriented Recovery Enhancement, Acceptance and Commitment Therapy, and Dialectical Behavioral Therapy, Meditation-CBT, Mindfulness-Based Care for Chronic Pain, Self-Compassion course and Loving-Kindness course. Pain intensity scores were reported using a numerical rating scale (0-10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP. Conclusion MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data and the high variability in study methodologies. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.

Effects of bisphosphonates and treadmill exercise on bone and kidney in adenine-induced chronic kidney disease rats

Article

Oct 2023

The increasing prevalence of osteoporosis and chronic kidney disease (CKD) due to the aging of society has highlighted the need for development of effective treatments for elderly patients. This study examined whether the combination of treadmill exercise therapy and alendronate (ALN) can improve bone mineral density (BMD) and bone strength without worsening renal function in adenine-induced CKD model rats. 8-week-old male Wistar rats (n = 70) were divided into experimental groups based on the treatment protocol, i.e., non-CKD (control), vehicle only (CKD), ALN only, exercise only, and combined ALN plus exercise. A 0.75% adenine diet was used to induce CKD. Groups were killed at either 20 or 30 weeks of age. Comprehensive assessments included serum and urine biochemistry tests, renal histology, bone histomorphometry, BMD measurement, micro-computed tomography examinations, and biomechanical testing. Blood biochemistry tests, urine analyses and histological evaluations of the kidney demonstrated that ALN treatment did not worsen renal function or kidney fibrosis in moderate-stage CKD model rats. Both ALN and treadmill exercise significantly suppressed bone resorption (p < 0.05–p < 0.01). Moreover, ALN monotherapy and combined ALN and treadmill exercise significantly improved BMD of the lumbar spine and femur, bone microstructure, and trabecular bone strength (p < 0.05–p < 0.01). Treadmill exercise was also shown to decrease cortical porosity at the mid-diaphysis of the femur and improve kidney fibrosis. The combination of ALN and treadmill exercise is effective in improving BMD, the microstructure of trabecular and cortical bone, and bone strength, without compromising renal function in adenine-induced CKD model rats.

Effectiveness of interferential current in patients with chronic non-specific low back pain: a systematic review with meta-analysis

Article

Sep 2023
REV BRAS FISIOTER

Effect of Regular Electrotherapy on Spinal Flexibility and Pain Sensitivity in Patients with Chronic Non-Specific Neck Pain and Low Back Pain: A Randomized Controlled Double-Blinded Pilot Trial

Article

Full-text available

Apr 2023

Background and Objectives: Chronic neck pain and low back pain are common conditions in high-income countries leading to social and medical problems such as invalidity and decreased quality of life. The aim of this study was to investigate the effect of supra-threshold electrotherapy on pain level, subjective feeling of disability, and spinal mobility in patients with chronic pain in the spinal cord. Materials and Methods: 11 men and 24 women with a mean age of 49 years were randomly divided into three groups: group 1, “therapy”: supra-threshold electrotherapy was applied on the whole back after electrical calibration; group 2, “control”: electrical calibration without successive electrotherapy; group 3, “control of control”: no stimulation. Sessions were performed once a week and six times in total, each lasting 30 min. The numeric pain rating scale (NRS), cervical and lumbar range of motion (ROM), as well as disability in daily live were investigated before and after the sessions using questionnaires (Neck Disability Index, Roland Morris Questionnaire, Short-form Mc Gill Pain Questionnaire (SF-MPQ)). Results: Spinal mobility improved significantly in the lumbar anteflexion (baseline mean, 20.34 ± SD 1.46; post session mean, 21.43 ± SD 1.95; p = 0.003) and retroflexion (baseline mean, 13.68 ± SD 1.46; post session mean, 12.05 ± SD 1.37; p = 0.006) in the group receiving electrotherapy. Pain levels measured by the NRS and disability-questionnaire scores did not differ significantly before and after treatment in any of the groups. Conclusions: Our data indicate that regular supra-threshold electrotherapy for six times has a positive effect on lumbar flexibility in chronic neck pain and low back pain patients, whereas pain sensation or subjective feeling of disability remained unchanged.

Effect of Transcutaneous Electrical Nerve Stimulation on Pain-related Quantitative Sensory Tests in Chronic Musculoskeletal Pain and Acute Experimental Pain: Systematic Review and Meta-analysis

Article

Apr 2023

This report provides a systematic review of the literature to analyze the effects of transcutaneous electrical nerve stimulation (TENS) on analgesia on sensitization measures, in studies with chronic musculoskeletal pain and in studies with acute experimental pain. The protocol was registered at PROSPERO (CRD42020213473). The authors searched CENTRAL, CINAHL, EMBASE, LILACS via BVS, PEDro, PubMed, Science Direct, Web of Science, Google Scholar, and hand-searched reference lists were also conducted. Among 22,252 manuscripts found, 58 studies were included in the systematic review, and 35 in the meta-analysis. Thirty-four studies assessed pain intensity; 24 studies investigated hyperalgesia; temporal summation was only evaluated in two studies; and conditioned pain modulation was not observed in the included studies. Meta-analyses favored TENS, despite its limitations and heterogeneity. Primary hyperalgesia in studies with musculoskeletal pain presented a high level of evidence, while other outcomes presented moderate evidence in the studies that were included. It is not possible to infer results about both temporal summation and conditioned pain modulation. Moderate evidence suggests that TENS promotes analgesia by reducing both central and peripheral sensitization, as shown by the reduction in primary and secondary hyperalgesia, pain intensity at rest, and during movement in the experimental acute pain and chronic musculoskeletal pain. Overall, both types of studies analyzed in this review presented meta-analyses favorable to the use of TENS (compared to placebo TENS), showing reductions in both primary and secondary hyperalgesia, as well as decreases in pain intensity at rest and in motion. PERSPECTIVE: This article presents data from the literature on the effect of TENS through sensitization assessments in individuals with chronic musculoskeletal pain, or acute experimental pain. These data contribute to knowledge about pain neuroscience research, using TENS technology.

Complimentary Non-pharmacological and Non-opioid Options

Chapter

Mar 2023

With the expansion of the multimodal approach to analgesia and anxiolysis, complementary techniques have been studied and employed to enhance a patient’s comfort throughout their anesthetic. Relaxation and distraction techniques, cognitive behavioral therapy, relaxation acupuncture, touch therapy TENS, massage, cryotherapy, and biofeedback have all been used as alternative approaches. Often these techniques are used in conjunction with pharmacologic means to alleviate pain and facilitate care. This chapter will explore the above techniques and the scientific evidence analyzing their utility.

Comparison of the effectiveness of conventional physical therapy and extracorporeal shock wave therapy on pain, disability, functional status, and depression in patients with chronic low back pain

Article

Full-text available

Aug 2022

Objectives: The aim of this study was to compare the effectiveness of conventional physical therapy (transcutaneous electrical nerve stimulation, hot pack, and therapeutic ultrasound) and extracorporeal shock wave therapy (ESWT) on pain, disability, functional status, and depression in patients with chronic low back pain (LBP). Patients and methods: Ninety-one patients with chronic LBP were included in the study and randomized to groups that received ESWT or conventional physiotherapy; of these, 70 completed the study (37 males, 33 females; mean age: 46.4±13.3 years; range, 18 to 65 years). Outcome measures included the Visual Analog Scale, the pressure pain algometer, Oswestry Disability Index (ODI), Health Assessment Questionnaire (HAQ), fingertip-to-floor distance, and the Beck Depression Inventory. The assessments were made before treatment and at the first and 12 th weeks after treatment. Results: Extracorporeal shock wave therapy was more effective than conventional physical therapy in terms of Visual Analog Scale scores, the pressure algometer, ODI, HAQ, and fingertip-to-floor distance at the first and 12 th week. Conclusion: Extracorporeal shock wave therapy is superior to conventional physical therapy in terms of improving pain, spinal mobility, and functional status in patients with chronic LBP.

Effects of Transcutaneous Electrical Nerve Stimulation in Patients with Chronic Non-Specific Low Back Pain

Article

Jul 2022

The management of low back pain (LBP) encompasses a diverse range of possible interventions including drug therapy, surgery, exercise, patient education, physiotherapy, cognitive-behavioral therapy and various other non-pharmacological therapies. Acute and chronic LBP warrant separate consideration as they may respond differently to the same interventions. Transcutaneous electrical nerve stimulation (TENS) is widely used as a therapeutic adjunct in the management of low back pain. It is relatively safe, non-invasive and easy to use modality that makes it an attractive treatment option. For more than four decades, TENS has been applied in the treatment of acute and chronic pain syndromes. Hence there is still uncertainty about the most effective therapeutic approach in chronic non-specific low back pain. Methods: This randomized controlled clinical trial was conducted in the department of Physical Medicine and Rehabilitation, Chatto gram from 13/01/2019 to 13/06//2019. The aim of the study was to evaluate the effects of Transcutaneous Electrical Nerve Stimulation on Chronic Non-specific Low Back Pain Patients. 120 patients with chronic low back pain were treated according to inclusion & exclusion criteria. Patients were equally distributed in three groups. Group-A patients (n=40) treated with NSAID+ADL, and Group-B patients (n=40) treated with NSAID+ADL+TENS and Group-C patients (n=40) treated with NSAID+ ADL+ Back extension exercise. Written informed consent was obtained from all patients. Data were calculated and analyzed by computer based software SPSS (Statistical Package for social Science) windows 16.0 version. Main Outcome Measure (S): Age, Sex, Occupational status, Socio-economic status, Subjective pain intensity score, Visual Analogue Scale, Tenderness index, Disability due to pain, Spinal mobility index, Oswestry disability Index. Results: The mean age was found 41.82±11.95 years in group A and 42.7±12.52 years in group B and 40.52±13.40 in group C.........

Effects of Different Trunk Training Methods for Chronic Low Back Pain: A Meta-Analysis

Article

Full-text available

Mar 2022
Int J Environ Res Publ Health

We conducted a systematic review and meta-analysis comparing motor control, isometric, and isotonic trunk training intervention for pain, disability, and re-injury risk reduction in chronic low back pain patients. The EMBASE, MEDLINE, CENTRAL, PsycINFO, SPORTDiscus, and CINAHL databases were searched from inception until 25 February 2021 for chronic low back pain intervention based on any trunk training. Outcomes include the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) for disability, the Numerical Pain Rating Scale (NPRS) for pain, and the Sorensen Test (ST) for future risk of re-injury. Isometric training was superior to the control with a mean difference (MD) = −1.66, 95% confidence interval (CI) [−2.30, −1.01] in pain reduction; MD = −7.94, 95% CI [−10.29, −5.59] in ODI; MD = −3.21, 95% CI [−4.83, −1.60] in RMDQ; and MD = 56.35 s, 95% CI [51.81 s, 60.90 s] in ST. Motor control was superior to the control with a MD = −2.44, 95% CI [−3.10, −1.79] in NPRS; MD = −8.32, 95% CI [−13.43, −3.22] in ODI; and MD = −3.58, 95% CI [−5.13, −2.03] in RMDQ. Isometric and motor control methods can effectively reduce pain and disability, with the isometric method reducing re-injury risk.

Transkutane elektrische Nervenstimulation (TENS)

Chapter

Feb 2022

Pieter van Kerkhof

Noninvasive Treatment Options for Glenohumeral Osteoarthritis in the Young Patient

Chapter

Jan 2022

Glenohumeral osteoarthritis is a challenging problem to treat, especially in younger patients. While many invasive and operative options exist, the foundation of any treatment plan should begin with noninvasive therapy. The provider should be familiar with appropriate diet, supplements, and medications that can help relieve pain and improve function. Additional treatment options such as formal physical therapy, physician-directed home exercise, acupuncture, electrical stimulation, ultrasound, iontophoresis, kinesiology taping, blood flow restriction, and temperature therapy should all be considered as well. While limited scientific evidence exists in support of most noninvasive treatment options, their low-risk nature and anecdotal effectiveness nevertheless make them a key part of managing glenohumeral osteoarthritis in young patients.KeywordsGlenohumeral osteoarthritisShoulder arthritisYoung patientNonoperativeNoninvasiveAlternative therapyLow risk

Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial

Article

Full-text available

Jan 2022

Importance Therapeutic aquatic exercise is frequently offered to patients with chronic low back pain, but its long-term benefits are unclear. Objective To assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain. Design, Setting, and Participants This 3-month, single-blind randomized clinical trial with a 12-month follow-up period was performed from September 10, 2018, to March 12, 2019, and the trial follow-up was completed March 17, 2020. A total of 113 people with chronic low back pain were included in the experiment. Interventions Participants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group. The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. Both interventions were performed for 60 minutes twice a week for 3 months. Main Outcomes and Measures The primary outcome was disability level, which was measured using the Roland-Morris Disability Questionnaire; scores range from 0 to 24, with higher scores indicating more severe disability. Secondary outcomes included pain intensity, quality of life, sleep quality, recommendation of intervention, and minimal clinically important difference. Intention-to-treat and per-protocol analyses were performed. Results Of the 113 participants, 59 were women (52.2%) (mean [SD] age, 31.0 [11.5] years). Participants were randomly allocated into the therapeutic aquatic exercise group (n = 56) or the physical therapy modalities group (n = 57), and 98 patients (86.7%) completed the 12-month follow-up. Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences of −1.77 (95% CI, −3.02 to −0.51; P = .006) after the 3-month intervention, −2.42 (95% CI, −4.13 to −0.70; P = .006) at the 6-month follow-up, and −3.61 (95% CI, −5.63 to −1.58; P = .001) at the 12-month follow-up (P < .001 for overall group × time interaction). At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain (at least a 2-point improvement on the numeric rating scale) (most severe pain, 30 [53.57%] vs 12 [21.05%]; average pain, 14 [25%] vs 11 [19.30%]; and current pain, 22 [39.29%] vs 10 [17.54%]) and disability (at least a 5-point improvement on the Roland-Morris Disability Questionnaire) (26 [46.43%] vs 4 [7.02%]). One of the 56 participants (1.8%) in the therapeutic aquatic exercise group vs 2 of the 57 participants (3.5%) in the physical therapy modalities group experienced low back pain and other pains related to the intervention. Conclusions and Relevance The therapeutic aquatic exercise program led to greater alleviation in patients with chronic low back pain than physical therapy modalities and had a long-term effect up to 12 months. This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation. Trial Registration Chinese Clinical Trial Registry: ChiCTR1800016396

ОПЕРАТИВНО ЛЕЧЕНИЕ НА ЛУМБАЛНИ ДИСКОВИ ХЕРНИИ

Book

Full-text available

Aug 2021

Mladen Ovcharov

Лечението на лумбалната дискова херния е предмет на постоянна дискусия между терапевти и спинални хирурзи. В повечето случаи хирургичното лечение бързо облекчава болевата симптоматика, заедно с възстановяване на функционалността на пациента. Използването на операционен микроскоп при хирургичното лечение ( Ящагрил, Каспар 1977г.) се налага като „златен стадарт“ през 80-те години на 20-ти век. В последните години навлизат разнообразни софистикирани методики, изискващи значителен финансов ресурс и клиничен опит. Темата е свързана с проучване и оценка на резултатите от лечението на лумбалната дискова херния (лДХ) чрез отворена стандартна дискектомия (СОД), микродискектомия (МД), сравнени с резултати от консервативно лекувани пациенти. Използвани са общоприети критерии за включване в проучването и отчитане на изхода: визуална аналогова скала (VAS), ODI (обективизиране на функционална инвалидност в ежедневието на пациента), ЯМР скала на Phirman (ЯМР оценка на интервертебралния диск), MacNaab критерий (ниво на удоволетвореност на пациента след оперативното лечение). Проучени са ранните следоперативни усложнения (до 30-ия ден) по скалата на Cliven-Dindo. Акцент на монографията е клиничната ефективност на СОД, която остава актуална методика в арсенала на опитен хирург, статистически доказано в резултатите и изводите на този труд.

Comparative effect of lumbar myofascial release with electrotherapy on the elastic modulus of lumbar fascia and pain in patients with non-specific low back pain

Article

Oct 2021

Objectives Low back pain is a major health issue in most industrialized countries. Lumbar fascia is supported as a potential source of pain in the lumbar region. Myofascial release is a manual therapeutic approach that focuses on restoring altered soft tissue function. On the other hand, one of the most commonly used physical therapy methods for low back pain is electrotherapy. The purpose of this study was to compare the effect of lumbar Myofascial release and electrotherapy on clinical outcomes of Non-specific low back pain and elastic modulus of lumbar myofascial tissue. Design Randomized, clinical trial. Setting Outpatient Low back pain clinic. Subjects 32 subjects with low back pain. Interventions Subjects were randomized into the myofascial release group (n = 16) and electrotherapy group(n = 16). Subjects in the myofascial release group received 4 sessions of myofascial release in the lumbar region, and the electrotherapy group received 10 sessions of electrotherapy. Main measures Low back pain severity, and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment. Results An independent sample T-test was used to compare baseline variables in both groups (p > 0.05) (effect size≥0.83), Paired T-test was used to compare within-group changes after performing myofascial release and electrotherapy (p ≤ 0.023) (effect size≥0.56), and the GLM Anova test was used to Comparison of Changes in the Elastic Modulus of the Lumbar Spine and Low Back Pain between-group (F (10,21) = 12.10, P < 0.0005) (effect size = 0.86). Conclusion The improvements in the outcome measures suggest that lumbar myofascial release may be effective in subjects with non-specific low back pain. Data suggest that the elastic modulus of lumbar fascia and the severity of low back pain are directly linked. Decreasing the elastic modulus after myofascial release can directly affect reducing low back pain.

A Review on Transcutaneous Electrical Nerve Stimulation and its Applications

Article

Full-text available

Dec 2021

Neuropathic pain is experienced when the human nervous system is malfunctioning and is commonly observed in 1 /10th of the population aged above 30 years. Transcutaneous Electrical Nerve Stimulation (TENS) is a technique in which electrical currents are delivered to a person in pain with the help of electrodes and its controlling circuit. The objective of this manuscript is to understand the theory of TENS, its types, electrode placement of TENS for various applications. We also identify the uses, precautions, and contradictions of TENS as a complete system and its various applications in the field of medicine such as dentistry, dermatology, and orthopedics. The effectiveness of TENS depends on the type of application it is being used in. TENS therapy, however, has a few minor side effects. Dysaesthesia (abnormal sensation), nausea, dizziness, or fainting are just a few examples. There is a split of opinions in the medical field on whether or not to use TENS. In this survey, we have provided a brief summary of the studies done on the topic of TENS and its applications.

Motor neurorehabilitation in patients with epileptic seizures: limitations of methods with proven efficacy in stroke

Article

Full-text available

Apr 2021

Patients with epilepsy may require a neurorehabilitation aid particularly due to developing motor alterations related to stroke, sequelae of traumatic brain injury, multiple sclerosis and other brain damage. Modern neurorehabilitation approaches directly or indirectly affect neuroplastic processes altering cerebral cortex excitability, stimulate the afferentation systems, and result in fatigue and may act as factors provoking seizures or aggravated epilepsy. In addition, developing seizures may temporarily coincide but unrelated to the neurorehabilitation activities: e.g., while omitting antiepileptic drug administration, sleep deprivation or long-term stress occurring to patient etc. Here we present a review on recent studies aimed at investigating epilepsy triggers by aligning them with the factors of interventions used in motor rehabilitation. We also emphasize the safety data for routine use of the main neurorehabilitation methods as well as propose actions to reduce the risk of developing epileptic seizure.

Exploring Why People with Back Pain Use the Pain Management Strategies They Do: Is Research Looking in the Wrong Places?

Article

Aug 2021

Low back pain (LBP) is a significant issue with considerable impact on people’s lives and economies. A plethora of research investigates interventions to manage LBP. However, despite considerable knowledge translation efforts, individuals with the condition frequently use management strategies considered to be ‘ineffective’. To address this concern, our aim was to explore why people with LBP choose the management strategies they do. Methods We employed a predominantly inductive, descriptive qualitative design. We interviewed 20 Australian adults who have, or have had, LBP to investigate the management strategies they have employed and why. Data were analysed thematically. Results Analysis identified three interrelated themes that highlight that participants chose management strategies, at least in part, because they: 1) reduce symptoms in the very short-term (e.g., immediately, a few hours); 2) have effects beyond the condition (e.g., low cost, lack of negative side effects, convenience, social effects); and 3) are pleasurable. Discussion These outcomes suggest that people with LBP are likely to have nuanced reasons for choosing the management strategies they use, and this can contrast with the outcomes tested in empirical studies. Our findings suggest that researchers may need to broaden or rethink which outcomes they measure and how, including by meaningfully engaging consumers in research design. Further, clinicians could better explore their patient’s reasons for using the strategies they do, before suggesting they discard existing strategies, or offering new ones.

Comparing an e-Health program vs home rehabilitation program in patients with non-specific low back pain: A study protocol randomized feasibility trial

Article

Jul 2021
J BACK MUSCULOSKELET

Background: There is little evidence on the reliability of the web application-based rehabilitation systems to treat chronic low back pain (CLBP). Methods: This protocol describes a double-blind, randomized controlled feasibility trial of an e-Health intervention developed to support the self-management of people with CLBP in primary care physiotherapy. Three Hospitals with primary care for outpatients will be the units of randomisation, in each Hospital the participants will be randomized to one of two groups, a pragmatic control group receiving either the usual home program based on electrostimulation and McKenzie Therapy and e-Health intervention. Patients are followed up at 2 and 6 months. The primary outcomes are (1) acceptability and demand of the intervention by GPs, physiotherapists and patients and (2) feasibility and optimal study design/methods for a definitive trial. Secondary outcomes will include analysis in the clinical outcomes of pain, disability, fear of movement, quality of life, isometric resistance of the trunk flexors, lumbar anteflexion and lumbar segmental range of motion. Discussion: The specific e-Health programs to home could increase adherence to treatment, prevent stages of greater pain and disability, and improve the painful symptomatology. Conclusions: The e-Health programs could be an effective healthcare tool that can reach a large number of people living in rural or remote areas.

The effects of TENS, interferential stimulation, and combined interferential stimulation and pulsed ultrasound on patients with disc herniation-induced radicular pain

Article

Jun 2021
J BACK MUSCULOSKELET

Background: Electrotherapy is part of a physician's toolbox for treating various musculoskeletal conditions, including radicular pain, but the preferred modality is yet unclear. Objective: To compare the short-term efficacy of three electrotherapeutic modalities in relieving lumbar disc herniation (LDH)-induced radicular pain. Methods: Fourteen patients with LDH-induced radicular pain attended a single session of electrotherapy, which included four 10-min consecutive treatments: transcutaneous electrical nerve stimulation (TENS), interferential (IF) stimulation, a combined treatment with pulsed ultrasound and IF current (CTPI), and a sham control. Treatments were randomized and the straight leg raise (SLR) degree was measured immediately before and after each treatment. Results: Each of the three active modalities significantly improved the SLR score. The most prominent improvement was observed in the CTPI condition, followed by IF and, finally, TENS. The sham stimulation did not affect the SLR scores. Conclusions: A single session with either TENS, IF current or CTPI is sufficient to improve the range of motion and degree of radicular pain associated with LDH. CTPI appears to be the most effective modality of the three, possibly due to greater penetration efficiency of the induced current. The effects of a long-term treatment schedule are yet to be identified.

Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Low Back Pain

Article

Full-text available

Oct 2001

Introduction. A structured and rigorous methodology was developed for the formulation of evidence-based clinical practice guidelines (EBCPGs), then was used to develop EBCPGs for selected rehabilitation interventions for the management of low back pain. Methods. Evidence from randomized controlled trials (RCTs) and observational studies was identified and synthesized using methods defined by the Cochrane Collaboration that minimize bias by using a systematic approach to literature search, study selection, data extraction, and data synthesis. Meta-analysis was conducted where possible. The strength of evidence was graded as level I for RCTs or level II for nonrandomized studies. Developing Recommendations. An expert panel was formed by inviting stakeholder professional organizations to nominate a representative. This panel developed a set of criteria for grading the strength of both the evidence and the recommendation. The panel decided that evidence of clinically important benefit (defined as 15% greater relative to a control based on panel expertise and empiric results) in patient-important outcomes was required for a recommendation. Statistical significance was also required, but was insufficient alone. Patient-important outcomes were decided by consensus as being pain, function, patient global assessment, quality of life, and return to work, providing that these outcomes were assessed with a scale for which measurement reliability and validity have been established. Validating the Recommendations. A feedback survey questionnaire was sent to 324 practitioners from 6 professional organizations. The response rate was 51%. Results. Four positive recommendations of clinical benefit were developed. Therapeutic exercises were found to be beneficial for chronic, subacute, and postsurgery low back pain. Continuation of normal activities was the only intervention with beneficial effects for acute low back pain. These recommendations were mainly in agreement with previous EBCPGs, although some were not covered by other EBCPGs. There was wide agreement with these recommendations from practitioners (greater than 85%). For several interventions and indications (eg, thermotherapy, therapeutic ultrasound, massage, electrical stimulation), there was a lack of evidence regarding efficacy. Conclusions. This methodology of developing EBCPGs provides a structured approach to assessing the literature and developing guidelines that incorporates clinicians' feedback and is widely acceptable to practicing clinicians. Further well-designed RCTs are warranted regarding the use of several interventions for patients with low back pain where evidence was insufficient to make recommendations.

Conservative Treatment of Acute and Chronic Nonspecific Low Back Pain

Article

Full-text available

Sep 1997

Study Design. A systematic review of randomized controlled trials. Objectives. To assess the effectiveness of the most common conservative types of treatment for patients with acute and chronic nonspecific low back pain. Summary of Background Data. Many treatment options for acute and chronic low back pain are available, but little is known about the optimal treatment strategy. Methods. A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results. Results. The number of randomized controlled trials identified varied widely with regard to the interventions involved. The scores ranged from 20 to 79 points for acute low back pain and from 19 to 79 points for chronic low back pain on a 100‐point scale, indicating the overall poor quality of the trials. Overall, only 28 (35%) randomized controlled trials on acute low back pain and 20 (25%) on chronic low back pain had a methodologic score of 50 or more points, and were considered to be of high quality. Various methodologic flaws were identified. Strong evidence was found for the effectiveness of muscle relaxants and nonsteroidal anti‐inflammatory drugs and the ineffectiveness of exercise therapy for acute low back pain; strong evidence also was found for the effectiveness of manipulation, back schools, and exercise therapy for chronic low back pain, especially for short‐term effects. Conclusions. The quality of the design, execution, and reporting of randomized controlled trials should be improved, to establish strong evidence for the effectiveness of the various therapeutic interventions for acute and chronic low back pain.

A Controlled Trial of Transcutaneous Nerve Stimulation (TENS) and Exercise for Chronic Low Back Pain

Article

Full-text available

Jul 1990

A number of treatments are widely prescribed for chronic back pain, but few have been rigorously evaluated. We examined the effectiveness of transcutaneous electrical nerve stimulation (TENS), a program of stretching exercises, or a combination of both for low back pain. Patients with chronic low back pain (median duration, 4.1 years) were randomly assigned to receive daily treatment with TENS (n = 36), sham TENS (n = 36), TENS plus a program of exercises (n = 37), or sham TENS plus exercises (n = 36). After one month no clinically or statistically significant treatment effect of TENS was found on any of 11 indicators of outcome measuring pain, function, and back flexion; there was no interactive effect of TENS with exercise. Overall improvement in pain indicators was 47 percent with TENS and 42 percent with sham TENS (P not significant). The 95 percent confidence intervals for group differences excluded a major clinical benefit of TENS for most outcomes. By contrast, after one month patients in the exercise groups had significant improvement in self-rated pain scores, reduction in the frequency of pain, and greater levels of activity as compared with patients in the groups that did not exercise. The mean reported improvement in pain scores was 52 percent in the exercise groups and 37 percent in the nonexercise groups (P = 0.02). Two months after the active intervention, however, most patients had discontinued the exercises, and the initial improvements were gone. We conclude that for patients with chronic low back pain, treatment with TENS is no more effective than treatment with a placebo, and TENS adds no apparent benefit to that of exercise alone.

Philadelphia Panel evidence-based clinical practise guidelines on selected rehabilitaion intervantions for low back pain

Article

Jan 2002

P. Philadelphia

Transcutaneous Electrical Nerve Stimulation for Low Back Pain: A Comparison of TENS and Massage for Pain and Range of Motion

Article

Apr 1983

Patients with acute or chronic low back pain were treated in a double-blind study that compared transcutaneous electrical nerve stimulation at intense levels and gentle, mechanically administered massage. Transcutaneous electrical nerve stimulation produced significantly greater pain relief, based on two measures of the McGill Pain Questionnaire, and significant improvement in straight leg raising. There were no significant differences between the two groups in back-flexion scores. Pain-relief scores and range-of-motion scores were significantly correlated. The results indicate that pain-relief scores provide valuable information and can easily be obtained from patients for whom pain is a major symptom.

Meta-analysis decision analysis and cost-effectiveness analysis. Methods for quantitative synthesis in medicine

Article

Jan 1994

D.B. Petitti

The clinical course of low back pain

Article

Jan 1998

G. Waddell

The epidemiology of spinal disorders

Article

Jan 1991

GBJ Anderson

Meralgia paresthetica and low back pain

Article

Dec 2004

on were noted. Electroneuromyography (ENMG) and radiologic studies of lumbosacral and pelvic region were performed in all patients. The patients were divided in to two groups regarding ENMG results: The patients with no sensorial response at the distribution area of lateral femoral cutaneous nerve (LFCN) (group A, 22 patients) and those with normal LFCN responses (group B, 18 patients). Mann Whitney U and chi-square tests were used for statistical analyses. Results:Female/male ratio was 0.9 and the mean age was 55.4 ± 12.5 (27–75) years. Six patients were police-men, 6 were obese, 3 had story of pelvic laparascopy, 3 had carpal tunnel syndrome and 4 were diabetic. The remaining patients had no history of risk factors or disorders that may be related to MP like symptoms. Symptoms were aggravated by hip extension in 77.3% of real MP patients. The prevalence of low back pathologies including disc hernia, spinal stenosis and degenerative changes in group A and B was 54.5% and 94.4% respectively. Conclusion:The patients with MP like symptoms and findings may have low-back pathologies without any evidence of abnormal LFCN responses in ENMG. Symptom aggravation as a result of hip extension may be considered in favor of MP. But, we recommend applying ENMG to confirm or rule out the MP diagnosis.

Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American college of physicians and the American pain society

Article

Oct 2007

Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits-for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).

Transcutaneous electrical nerve stimulation for pain management

Article

Jan 1999

J.O. Barr

Efficacy of transcutaneous electrical nerve stimulation and percutaneous neuromodulation therapy in chronic low back pain

Article

Dec 2004

The study was designed to compare the efficacy of two different modalities of transcutaneous electrical nerve stimulation (conventional and low-frequency TENS) (C-TENS and Low-TENS) and percutaneous neuromodulation therapy (PNT) in the treatment of chronic low back pain. Sixty patients with chronic low back pain were randomly divided into four groups as placebo-TENS, C-TENS, Low-TENS, and PNT. Therapeutic modalities were administered for 2 weeks. The pre-treatment and post-treatment assessments were done by using the Visual Analog Scale for pain; Low Back Pain Outcome Scale and Oswestry Disability Index for functional disability; and Health Status Survey Short Form (SF-36) for quality of life. In placebo-TENS group only emotional role limitation score of SF-36 significantly decreased after the treatment. All measurements except emotional role limitation score of SF-36 significantly improved in C-TENS group after the treatment. In both of Low-TENS and PNT groups, all parameters were significantly improved by the treatment. TENS modalities and PNT were significantly more effective than the placebo-TENS. No significant difference was found between C-TENS and Low-TENS. PNT was significantly more effective than TENS in providing relief of activity pain and in improving general health, vitality and emotional role limitation scores of health quality.

Epidemiology of mental disorders

Article

Jan 1999

Relief of chronic pain by brief, intense transcutaneous electrical stimulation: A double blind study

Article

Jan 1979
Adv Pain Res Ther

M.E. Jeans

Scientific approach to the assessment and management of activity-related spinal disorders. In Monograph for Clinicians: Report of the Quebec Task Force on Spinal Disorders

Article

Jan 1987

Pain Mechanisms: A New Theory

Article

Nov 1965

Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations

Article

Feb 2001

Claire Bombardier

Clinicians and researchers increasingly recognize the importance of the patient's perspective in the evaluations of the effectiveness of treatment. The rapid growth in the number and types of patient-based outcome measures can be confusing. This supplement provides a state-of-the-art review of the available tools. In this paper, the key recommendations from the participating authors are summarized. A core set of measures should include the following five domains: back specific function, generic health status, pain, work disability, and patient satisfaction. Two commonly used measures of back-specific function are recommended: the Roland-Morris Disability Questionnaire and the Oswestry Disability Index. Among the generic measures, the SF-36 strikes the best balance between length, reliability, validity, responsiveness, and experience in large populations of patients with back pain. Moreover, the SF-36 Bodily Pain Scale provides a brief measure of pain intensity and pain interference with activities. Health-related work disability should include at a minimum a measure of work status and work-time loss. For those who are still at work, new measures are being developed to measure health-related work limitations. No single measure of patient satisfaction is clearly preferred but guiding principles are provided to choose among available measures. In addition to the five recommended domains, preference-based health outcome measures, including patients utilities, may be useful when there is a need to value alternative health outcomes.

Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society

Article

Oct 2007

Roger Chou

Recommendation 1: Clinicians should conduct a focused history and physical examination to help place patients with low back pain into 1 of 3 broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause. The history should include assessment of psychosocial risk factors, which predict risk for chronic disabling back pain (strong recommendation, moderate-quality evidence). Recommendation 2: Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). Recommendation 3: Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence). Recommendation 4: Clinicians should evaluate patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy) (strong recommendation, moderate-quality evidence). Recommendation 5: Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options (strong recommendation, moderate-quality evidence). Recommendation 6: For patients with low back pain, clinicians should consider the use of medications with proven benefits in conjunction with back care information and self-care. Clinicians should assess severity of baseline pain and functional deficits, potential benefits, risks, and relative lack of long-term efficacy and safety data before initiating therapy (strong recommendation, moderate-quality evidence). For most patients, first-line medication options are acetaminophen or nonsteroidal anti-inflammatory drugs. Recommendation 7: For patients who do not improve with selfcare options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation (weak recommendation, moderate-quality evidence).

Use of self-applied TENS for low back pain in people with multiple sclerosis

Article

Jun 2004

The aim of this study was to evaluate the use of self-applied transcutaneous electrical nerve stimulation (TENS) for low back pain in a population of people with multiple sclerosis (MS). In total, 15 participants diagnosed with MS (aged 37–71 years) presenting with low back pain were recruited and randomized into two active TENS groups and a placebo group under double-blind conditions (n=5 per group). Treatment involved self-application of TENS on a daily basis for 6 weeks. Outcome measures were recorded at weeks 1, 6, 10 and 32. Statistical analysis indicated significant changes in the McGill Pain Questionnaire affective subsection (P=0.01) throughout the trial. However, trends observed seem to indicate an improvement in both active TENS groups during the treatment period, with differential improvement maintained into the follow-up period. The findings of this study thus warrant further investigation by means of a randomized, controlled clinical trial within this population.

One-Shot Percutaneous Electrical Nerve Stimulation vs. Transcutaneous Electrical Nerve Stimulation for Low Back Pain

Article

Nov 2002

Hsieh RL, Lee WC: One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: Comparison of therapeutic effects. Am J Phys Med Rehabil 2002;81:838–843. Objective: To investigate the therapeutic effects of one shot of low-frequency percutaneous electrical nerve stimulation vs. one shot of transcutaneous electrical nerve stimulation in patients with low back pain. Design: In total, 133 low back pain patients were recruited for this randomized, control study. Group 1 patients received medication only. Group 2 patients received medication plus one shot of percutaneous electrical nerve stimulation. Group 3 patients received medication plus one shot of transcutaneous electrical nerve stimulation. Therapeutic effects were measured using a visual analog scale, body surface score, pain pressure threshold, and the Quebec Back Pain Disability Scale. Results: Immediately after one-shot treatment, the visual analog scale improved 1.53 units and the body surface score improved 3.06 units in the percutaneous electrical nerve stimulation group. In the transcutaneous electrical nerve stimulation group, the visual analog scale improved 1.50 units and the body surface score improved 3.98 units. The improvements did not differ between the two groups. There were no differences in improvement at 3 days or 1 wk after the treatment among the three groups. Conclusions: Simple one-shot treatment with percutaneous electrical nerve stimulation or transcutaneous electrical nerve stimulation provided immediate pain relief for low back pain patients. One-shot transcutaneous electrical nerve stimulation treatment is recommended due to the rarity of side effects and its convenient application.

Outcome Measures for Low Back Pain Research

Article

Sep 1998

Study Design. An international group of back pain researchers considered recommendations for standardized measures in clinical outcomes research in patients with back pain. Objectives. To promote more standardization of outcome measurement in clinical trials and other types of outcomes research, including meta‐analyses, cost‐effectiveness analyses, and multicenter studies. Summary of Background Data. Better standardization of outcome measurement would facilitate comparison of results among studies, and more complete reporting of relevant outcomes. Because back pain is rarely fatal or completely cured, outcome assessment is complex and involves multiple dimensions. These include symptoms, function, general well‐being, work disability, and satisfaction with care. Methods. The panel considered several factors in recommending a standard battery of outcome measures. These included reliability, validity, responsiveness, and practicality of the measures. In addition, compatibility with widely used and promoted batteries such as the American Academy of Orthopaedic Surgeons Lumbar Cluster were considered to minimize the need for changes when these instruments are used. Results. First, a six‐item set was proposed, which is sufficiently brief that it could be used in routine care settings for quality improvement and for research purposes. An expanded outcome set, which would provide more precise measurement for research purposes, includes measures of severity and frequency of symptoms, either the Roland or the Oswestry Disability Scale, either the SF‐12 or the EuroQol measure of general health status, a question about satisfaction with symptoms, three types of "disability days," and an optional single item on overall satisfaction with medical care. Conclusion. Standardized measurement of outcomes would facilitate scientific advances in clinical care. A short, 6‐item questionnaire and a somewhat expanded, more precise battery of questionnaires can be recommended. Although many considerations support such recommendations, more data on responsiveness and the minimally important change in scores are needed for most of the instruments.

Evidence-based medicine for non-specific low back pain

Article

Aug 2005
BEST PRACT RES CL RH

Maurits van Tulder

Symmetrical Biphasic TENS Waveform for Treatment of Back Pain

Article

Jan 1987

A review of the treatment of chronic low back pain with acupuncture-like transcutaneous electrical stimulation and transcutaneous electrical nerve stimulation

Article

Dec 1997
COMPLEMENT THER MED

A meta-analysis of published studies was carried out to evaluate the effectiveness of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) and transcutaneous electrical nerve stimulation (TENS) in controlling pain and improving function in patients with chronic low back pain. Studies in English were identified by searches of EMBASE, MEDLINE, CISCOM and AMED. Other studies were located by citation tracking, searching by hand bibliographies and conference reports, and direct contact with subject experts. Studies were included in the meta-analysis if they were randomized controlled trials comparing ALTENS or TENS with a credible placebo in patients with low back pain of more than 8 weeks duration. Two reviewers extracted data on reduction in pain, changes in range of movement and functional status as well as determining the power of the included studies. Sixty-eight studies were initially identified, of which six (two using ALTENS and four using TENS) involving a total of 288 patients with mixed low back pathologies met the inclusion criteria for meta-analysis. The odds ratio (OR) of improvement in pain was calculated: ALTENS/TENS vs placebo OR = 2.1 (95% Cl 1.3–3.4) ALTENS vs placebo OR = 7.2 (95% CI 2.6–20.1), TENS vs placebo OR = 1.5 (95% CI 0.9–2.6). OR for range of motion (ROM) on ALTENS vs placebo was 6.6 (95% CI 2.4–18.6). There were insufficient data to assess the effect of TENS alone on ROM, functional status and return to work. Similarly there were not enough data to assess ALTENS and functional status and return to work. There is limited statistical evidence that ALTENS and TENS reduce pain and improve function in patients with chronic low back pain, at least in the short term. This review and analysis is severely restricted by the lack of quality, randomized controlled trials. Even 25 years since the introduction of these treatments, powerful randomized controlled studies on the most appropriate use of TENS/ALTENS for the management of chronic low back pain have yet to be produced.

Evidence-Based Guide to Therapeutic Physical Agents

Article

Jan 2003

Alison Hoens

ONE: DIRECT, PULSED AND ALTERNATING CURRENTS1. Iontophoresis2. Transcutaneous Electrical Nerve Stimulation3. Interferential Current4. Microcurrent5. High Voltage Pulsed Current6. Russian Current7. Diadynamic Current TWO: RADIO-WAVE AND LIGHT RADIATION8. Shortwave Diathermy9. Laser THREE: ACOUSTIC RADIATION10. Ultrasound FOUR: INFRARED RADIATION11. Cryotherapy12. Thermotherapy13. Fluidotherapy FIVE: INFRARED RADIATION AND HYDROMECHANICS14. Hydrotherapy SIX: PRACTICAL GUIDELINES15. Electrical Hazards, Safety Measures and Maintenance of Line-Powered Physical Agents16. Skin Sensory Hot and Cold Discrimination Testing17. Quantitative Phyical Agent and Skin Temperature Measurement18. Temperature Ranges of Thermal Physical Agents19. Selection and Purchase of Therapeutic Physical Agents20. Equivalency Between the US and Metric Customary Units of Measuremen

AN INTEGRATIVE APPROACH TO LOW BACK PAIN

Article

Dec 2002
Clin Fam Pract

V SIERPINA

Low Back Pain: A Primary Care Approach

Article

Jun 2005
Clin Fam Pract

The majority of LBP is benign and can be treated with nonsurgical methods. The mainstays of therapy are continuing activity within limits of pain, lifestyle modification, analgesic and anti-inflammatory medicine, and supportive care. Red flags that should alarm providers include severe or progressive pain in patients over 50 years of age, history of malignancy, fevers, night symptoms, or neurologic compromise. These characteristics should prompt further work-up. Imaging is not necessary in most instances. Plain films can be used to evaluate for osseous lesion or fracture, and MRI can be used to evaluate for degenerative disc disease, herniated discs, and spinal stenosis. A surgical evaluation should be obtained for any patient with possible cauda equine or cord compression (symptoms of saddle anesthesia, urinary dysfunction) or when conservative management fails.

Epidemiology in Medicine

Book

Jan 1987

A randomised, single blind study to evaluate the effects of action potential simulator therapy compared with placebo in patients with chronic back pain

Article

Jun 2002

This study investigated a relatively new device known as the Action Potential Simulator (APS) for pain relief in chronic low back pain with or without leg pain. The study had a single blind and parallel group design. A total of 24 patients were studied. Twelve patients received treatment with the active device and twelve with a placebo machine. Treatments were given for 8 minutes on 5 consecutive days. The results of visual analogue scores were compared pre- and post-treatment with both machines. The Oswestry Back Pain Questionnaire was completed before and at the end of the study and the results compared. There were significant effects on the VAS [visual analogue score] from visit 4 onwards. Newman Keuls tests showed significant differences both at visit 4 (p = 0.03) and visit 5 (p = 0.021) of sham versus active treatments. In terms of SD, the sham effect was about one-eight SD and active was one-quarter SD. This is a very small effect for both active and sham APS. Thus we conclude that APS therapy for chronic back pain in our group of patients was found to produce a small but clinically insignificant reduction in pain and took about 4 consecutive daily visits to show this effect.

Transcutaneous electrical nerve stimulation (TENS) during epidural steroids injection: A randomized controlled trial

Article

Jun 2000

Although transcutaneous electrical nerve stimulation (TENS) is commonly used in the treatment of pain, its efficacy in relieving pain during invasive procedures is controversial. The aim of the present study was to investigate the analgesic effect of TENS during the injection of epidural steroids. Ninety patients with lumbar radicular pain due to disc herniation were randomly assigned to three treatment groups. The first received high-frequency TENS treatment, the second sham TENS (electrodes with sub-threshold electrical stimulation), and the third received no TENS (control). Pain level was measured using the 100 mm visual analogue scale (VAS) at the end of the procedure. Mean recorded procedural pain levels were 47 ? 7; 46 ? 5; 49 ? 5 for the TENS, sham TENS and control groups, respectively. These results indicate that TENS fails to reduce the pain associated with epidural steroid injection, and therefore, its efficacy in relieving procedural pain remains questionable.

Electrotherapy of Chronic Musculoskeletal Pain: Comparison of Electroacupuncture and Acupuncture-Like Transcutaneous Electrical Nerve Stimulation

Article

Jan 1987

This study compared two ways of treating chronic muculoskeletal pain, using randomized assignment of 131 patients to one of two electrotherapy methods: electroacupuncture or acupuncture-like TFNS. For the latter a new device called Codetron (Trademark of FHM) was used which had many features to ensure strong and unhahituated stimulation. For both methods, frequencies of 4 Hz and 200 Hz were used to optimize release of endorphins and serotonin. Initial outcomes were evaluated using visual analogue scales for pain relief and activity improvements. The "initial" outcomes during treatment weeks were not significantly different for both electrotherapy methods. Follow-up data were obtained by telephone 4 to 8 months after cessation of therapy: these were significantly better for Codetron than for eleetroaeupuncture but we must remain cautious about telephone interviews. (C) Lippincott-Raven Publishers.

Comparative effectiveness of different stimulation modes in relieving pain. Part II. A double-blind controlled long-term clinical trial

Article

Dec 1991

Part I of our earlier pilot study demonstrated that patients preferred modulated stimulation forms — frequency modulation and burst — rather than conventional continuous mode. To assess whether long-term therapeutic effects validate the immediate test results, this trial was performed in 14 patients with 21 pain conditions.Considering the results of the pilot study, the test stimulator was modified and 4 different forms of transcutaneous electrical nerve stimulation were randomly delivered to each patient who was blind to the modes of stimulation for 20 min. A second observer assessed the pain scores using visual analogue scales. The stimulation modes employed were: (1) conventional continuous stimulation (continuous pulses with a constant frequency of 70 Hz), (2) burst stimulation (80 msec long trains of pulses, each train consisting of 8 pulses, with an internal frequency of 90 Hz repeated 1.3 times a second), (3) high-rate frequency modulation, HRFM (continuous pulses changed from 90 Hz to 55 Hz over 90 msec, 1.3 times a second), (4) low-rate frequency modulation, LRFM (continuous pulses changed from 60 Hz to 20 Hz over 90 msec, 1.3 times a second).After the test treatment of 4 sessions in the clinic, depending on the pain scores and duration of pain relief recorded, the most effective stimulation mode was determined for each patient and a portable stimulator preset appropriately for that mode was given to be used at home, under our supervision, for 3 months.Fourteen pain conditions out of 21 (66%) responded well to the therapy; the majority preferred was the HRFM and burst-type stimulation. These results validate the initial testing of different stimulation modes before assessing long-term stimulation therapy.

The Discovery of Transcutaneous Spinal Electroanalgesia and Its Relief of Chronic Pain

Article

Nov 1995
PHYSIOTHERAPY

Transcutaneous spinal electroanalgesia (TSE) is a new method employing brief pulse durations (10 μsec or less) at relatively high voltage (50 V or more) that are designed to modulate processing of chronic pain when surface electrodes are placed on the skin overlying the spinal cord, without causing distress or side effects. In patients with chronic unilateral tenderness TSE significantly reduced tenderness as compared with the contra-lateral side (p < 0.001). A randomised, double-blind, cross-over clinical trial comparing the widespread analgesic effects of TSE with a control, showed the new method to be significantly superior (p < 0.005). TSE is well tolerated and can scarcely be felt. An advantage of TSE over peripheral nerve stimulation is that the surface electrodes are always placed over the spinal cord, regardless of the site(s) of pain.

Pain Relief by Transcutaneous Electric Nerve Stimulation With Bidirectional Modulated Sine Waves in Patients With Chronic Back Pain: A Randomized, Double-Blind, Sham-Controlled Study

Article

Jan 2007

Objectives. Newly developed bidirectional modulated sine waves (BMW) might provide some derived benefit to patients with low back pain. Pain relief by transcutaneous electric nerve stimulation (TENS) with BMWs was tested. Materials and Methods. Analgesic effects of BMWs and conventional bidirectional pulsed waves on chronic back pain in 28 patients were compared, and effects of repeated TENS using BMWs on chronic back pain were investigated in 21 patients by means of a randomized double-blind, sham-controlled, parallel-group method. Pain intensity was assessed using numerical rating scale (NRS). Results. There was significant immediate reduction in NRS in patients receiving BMWs, and 60 min after treatment compared to sham TENS. Weekly repeated treatments using massage and TENS with BMWs for 5 weeks resulted in a decrease of NRS, but there were no significant differences between the TENS plus massage and sham TENS plus massage groups. Conclusions. This study shows that TENS with BMWs significantly inhibits chronic back pain, and treatment effects are attained within a day. The results also suggest that there were no statistically significant long-term effects of TENS with BMW in the repeated treatment.

Statistical power ANALYSIS for the Behavioral sciences

Article

Jan 1988
J AM STAT ASSOC

Jacob Cohen

Incluye bibliografía e índice

Investigating and dealing with publication and other biases

Article

Jan 2001

Transcutaneous electrical stimulation for chronic pain relief. A pilot study

Article

Nov 1976
Minn Med

Acupuncture and Transcutaneous Electric Stimulation in the Treatment of Chronic Sacrolumbalgia and Ischialgia

Article

Feb 1976
Am J Chin Med

Jaakko Laitinen

A comparison was made between 50 patients treated with acupuncture and 50 patients treated with transcutaneous electric stimulation. All patients suffered from chornic sacrolumbalgia or ischialgia of more than six months' duration. Two to 10 treatments were given at weekly sessions, the mean being 5 in both groups. Stimulation points were selected by the same principle in both groups: one point ialong the course of the nerve trunk affected, and one point at a dermatome proximal to the affected segment. The stimulation was given bilaterally. Needles were inserted as deep as the muscular layer and twirled at 5 min intervals. In the electric stimulation square-wave impulses of 1.0 msec duration and 5.0 Hz frequency were used. The electrodes were 0.9 cm in diameter. Each acupuncture and electric stimulation was of 20 min duration. Pain relief was complete or moderate in the acupuncture group in 58% of the cases, and in 46% in the electric stimulation group. After 2 months 30 patients in the acupuncture group and 23 patients in the electric stimulation group still reported satisfactory relief of pain. After 6 months 15 patients in the acupuncture group and 10 patients in the electric stimulation of group still reported satisfactory relief of pain.

Electrical stimulation in chronic low-back pain

Article

Jul 1977

Since 1972, 367 patients with chronic low-back pain have been treated by electrical stimulation (e.s.). Patients with herniated disc lesions and spondylitis and allied conditions were included. Following e.s. 75–100% pain relief was obtained by 53% of the patients. 50% pain relief by 27% and there was no improvement in 20% of patients. In a follow-up of 208 patients, 6–36 months later, approximately 70% stated that pain relief was similar to that obtained at the end of treatment.

Transcutaneous electrical stimulation and acupuncture. Comparison of treatment of low back pain

Article

Jul 1976

Twelve patients suffering chronic low-back pain were treated with both acupuncture and transcutaneous electrical stimulation. The order of treatments was balanced, and changes in the intensity and quality of pain were measured with the McGill Pain Questionnaire. The results, based on a measure of overall pain intensity, show that pain relief greater than 33% was produced in 75% of the patients by acupuncture and in 66% by electrical stimulation. The mean duration of pain relief was 40 h after acupuncture and 23 h after electrical stimulation. Although the mean scores are larger for acupuncture than for transcutaneous stimulation, statistical analyses of the data failed to reveal significant differences between the two treatments on any of the measures. Both methods, therefore, appear to be equally effective, and probably have the same underlying mechanism of action. Consideration of the advantages and disadvantages of the two methods suggests that that transcutaneous electrical stimulation is potentially the more practical, since it can be administered under supervision by paramedical personnel.

The Placebo Effect of Transcutaneous Electrical Stimulation

Article

Jul 1978

The placebo effect of transcutaneous electrical stimulation was studied in 93 patients in a double-blind cross-over trial using a genuine stimulator and a placebo machine. Placebo analgesic effect occurred in 32% of trials, as compared with 48% for actual stimulation. The placebo effect of the transcutaneous electrical stimulator is similar to the placebo effect that is noted in other double-blind studies in which medications are used.

Transcutaneous Electrical Analgesia: A Follow-Up Analysis

Article

Apr 1976

One year follow-up data are analyzed for the effects of using transcutaneous neurostimulators on patients with chronic benign pain. Those who have successful surgery for pain relief have lower pain and analgesic intake levels than those who supplement their surgery with neurostimulation. Those who do not receive surgery for pain but use neurostimulators have greatly increased activity levels than those who do not use these devices. The neurostimulators lower the clinical pain level component of the tourniquet test score for non-surgery patients to a degree comparable to that of patients with successful surgical outcomes, but maximum pain tolerance is not significantly altered. This supports the hypothesis that the analgesic effect is primarily a peripheral one.

Epidemiology of low back pain

Article

Nov 1992
Bailliere Clin Rheumatol

M L Skovron

At present, although there have been many epidemiological studies of risk factors for low back pain, there are few risk factors established in prospective studies; and our understanding of them remains relatively crude. Individuals in jobs requiring manual materials handling, particularly repeated heavy lifting and lifting while twisting, are at increased risk of back pain leading to work absence. In addition, exposure to whole-body vibration and job requirements for static postures are associated with back pain. Individual trunk strength has not been consistently demonstrated as associated with back pain; although there is some suggestion that when work requirements for heavy lifting exceed individual capacities, back pain is more likely to occur. The pattern of peak age at onset in the 20's is consistent with back pain development early in working life. Among other individual characteristics, only cigarette smoking has consistently been associated with back pain; and the biological mechanism for this finding is not understood. Evidence with respect to spinal flexibility, aerobic capacity, educational attainment and other variables is suggestive but not consistent. There is some evidence that the individual's relation to work, expressed as job satisfaction or supervisor rating, is also related to work absence due to back pain. While it is possible to describe, however crudely, the characteristics placing people at risk for back pain leading to work absence and/or medical attention, the problem of predicting chronicity and thus identifying patients for more intensive clinical intervention remains unresolved. At this time, only age of the patient and certain clinical features of the back pain such as the presence of sciatic symptoms, duration of the current episode, and history of prior episodes are consistently demonstrated predictors. In chronic patients, there is suggestive evidence that spinal flexibility, trunk strength, and certain psychological characteristics such as coping skills, fear and avoidance of pain or movement, job satisfaction, attribution of fault and hysterical or hypochondriacal features are associated with treatment failure. In addition, there is suggestive evidence that the availability of alternative work placement may allow for earlier return to work than otherwise. While the availability of disability compensation in excess of usual wages may serve as a disincentive to return to work. The latter-cited remain to be verified, while findings in chronic patients remain to be tested in acute. Further, the role of physical demands of work in duration of back pain episodes has not been well studied.

Effect of Low-Frequency and High-Frequency TENS on Met-Enkephalin-Arg-Phe and Dynorphin-A Immunoreactivity in Human Lumbar CSF

Article

Jan 1992

Transcutaneous nerve stimulation (TENS) treatment was given for 30 min to 37 patients divided into 3 groups of 10 patients and 1 group of 7 patients. Two groups received low-frequency (2 Hz) and the other 2 groups high-frequency (100 Hz) stimulation. A diagnostic lumbar cerebrospinal fluid (CSF) sample was obtained immediately before and after stimulation. The CSF samples were subjected to analysis of immunoreactive (ir) opioid peptides, Met-enkephalin-Arg-Phe (MEAP) from preproenkephalin and dynorphin A (Dyn A) from preprodynorphin, respectively. Low frequency TENS applied on the hand and the leg resulted in a marked increase (367%, P less than 0.05) of ir-MEAP but not ir-Dyn A, whereas high-frequency (100 Hz) TENS produced a 49% increase in ir-Dyn A (P less than 0.01) but not ir-MEAP. This is the first report in humans that 2 Hz and 100 Hz peripheral stimulation induces differential release of peptides from preproenkephalin and preprodynorphin, respectively.

Transcutaneous electrical nerve stimulation in ankylosing spondyitis: A double-blind study

Article

Jun 1991

The consistency of pulse frequencies and pulse patterns of transcutaneous electrical nerve stimulation (TENS) used by chronic pain patients

Article

Apr 1991

This study records the consistency of transcutaneous electrical nerve stimulation (TENS) pulse frequency and pulse pattern used by 13 chronic patients over a 1 year period. The results show that patients prefer specific pulse frequencies and pulse patterns unique to the individual and that they turn to such frequencies and patterns on subsequent treatment sessions. Pulse frequencies and pulse patterns were not related to the cause and site of pain, a finding consistent with previous study in this laboratory. This observation, coupled with the large variability in pulse frequencies and pulse patterns used between individuals, implies that patients prefer such frequencies and patterns for reasons of comfort which may not be related to mechanisms specific to the pain system.

An in-depth study of long-term users of transcutaneous electrical nerve stimulation (TENS). Implications for clinical use of TENS

Article

Apr 1991

This in-depth study examines the relationships between patient, stimulator and outcome variables in a large number of chronic pain patients utilising TENS on a long-term basis. 179 patients completed a TENS questionnaire designed to record age, sex, cause and site of pain and TENS treatment regime. Of these 179 patients, 107 attended our research unit for assessment of the electrical characteristics of TENS during self-administered treatment. Although a remarkable lack of correlation between patient, stimulator and outcome variables was found to exist, the analysis revealed much information of importance: 47% of patients found TENS reduced their pain by more than half; TENS analgesia was rapid both in onset (less than 0.5 h in 75% patients) and in offset (less than 0.5 h in 51% patients); one-third of patients utilised TENS for over 61 h/week; pulse frequencies between 1 and 70 Hz were utilised by 75% of patients; 44% of patients benefitted from burst mode stimulation. The clinical implications of these findings are discussed.

Critical review of the epidemiology of backache

Article

Feb 1989
REV EPIDEMIOL SANTE

High frequency occurrence of back pain and the magnitude of its impact on society explain the large number of epidemiologic studies. Most investigators have considered back pain as a whole, without reference to different etiological types of back pain, probably for lack of an available classification of these types. Prevalence of back pain in general populations varies between 14 and 45% and annual incidence around 6%. Risk factors for low back pain are often social or cultural factors: smoking, driving, psychological stress. These factors seem to be far from the starting point of the disease process. Vagueness of case descriptions may explain in part the disappointing results of analytic surveys. Indistinctness of risk factors, especially workplace factors, is the principal reason for the poor results of intervention epidemiology: very few primary prevention programs and no educational programs ("low back school") have been shown to be really effective.

Efficacy of Electroacupuncture and TENS in the Rehabilitation of Chronic Low Back Patients

Article

Oct 1986

Fifty-four patients treated in a 3-week inpatient rehabilitation program were randomly assigned to and accepted treatment with electroacupuncture (n = 17), TENS (low intensity transcutaneous nerve stimulation, n = 18), and TENS dead-battery (placebo, n = 18). Outcome measures included estimates of pain (on a Visual Analogue Scale) and disability by both physician and patient, physical measures of trunk strength and spine range of motion, as well as the patient's perceptions of the relative contribution of the education, exercise training, and the electrical stimulation. Analyses of variance were utilized to determine effects of treatment (electroacupuncture, TENS, placebo) across time (admission, discharge, and return) for the outcome measures. There were no significant differences between treatment groups with respect to their overall rehabilitation. All 3 treatment groups ranked the contribution of the education as being greater than the electrical stimulation. However, the electroacupuncture group consistently demonstrated greater improvement on the outcome measures than the other treatment groups. For the visual analogue scale measure of average pain, there was a statistical trend at the return visit suggesting that the acupuncture group was experiencing less pain.

Descriptive Epidemiology of Low-back Pain and Its Related Medical Care in the United States

Article

May 1987

Accurate United States data on the prevalence of low-back pain (LBP) and its related medical care would assist health care planners, policy makers, and investigators. Data from the second National Health and Nutrition Examination Survey (NHANES II) were analyzed to provide such information. The cumulative lifetime prevalence of LBP lasting at least 2 weeks was 13.8%. In univariate analyses, important variations in prevalence were found by age, race, region, and educational status. Most persons with LBP sought care from general practitioners, with orthopaedists and chiropractors being the next most common sources of care. Sources of care, and in some cases therapy, varied among demographic subgroups. These data demonstrate substantial nonbiologic influences on the prevalence and treatment of LBP, and suggest an agenda for health services researchers.

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

Abstract

No full-text available

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