TENS (Transcutaneous Electrical Nerve Stimulation)
Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through w...

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Theory

TENS has been hypothesized to improve pain in multiple ways. Theories include effects on sensory nerves, interference with sensory-discriminative pathways, stimulation of release of natural chemicals that affect the way pain is perceived and transmitted (for example, encephalins and endorphins), or through increased blood flow in treated areas such as the skin or heart. Recent data suggest pain relief from low and high frequency TENS is mediated by the release of mu or delta-opioids, respectively, in the central nervous system, and reductions in substance P. However, none of these mechanisms has been clearly established in scientific research, and the basis of activity of TENS remains controversial. Theories used traditionally to explain acupuncture have also been offered, citing effects on flow of vital energy. It is also sometimes suggested that TENS may affect the cardiovascular system, increasing heart rate and reducing blood pressure.

Many studies of TENS compare the technique to "placebo" techniques in which a TENS-like control box and electrodes may be used without delivering electric current to the patient. However, patients can often tell if no current is delivered, which lessens the quality of these studies. Much of the research on TENS is not well designed or reported.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Dental procedures: Several small randomized controlled trials in adults and children report pain reduction or reduced need for pain medications during dental procedures with the use of various TENS techniques. These studies provide promising preliminary evidence but do not include clear descriptions of design or results. Therefore, better research is necessary before a strong recommendation can be made.
Grade: B

Knee osteoarthritis: Multiple randomized controlled trials have examined the effects of TENS in patients with osteoarthritis of the knee. Overall, the results suggest improvements in knee stiffness and pain, although it is not clear that walking distance or swelling are improved. The available studies have been small without clear descriptions of design or results. Therefore, better research is necessary before a strong recommendation can be made.
Grade: B

Anesthesia (pain relief during surgery): Auricular TENS is sometimes used in Europe to reduce the need for anesthesia during surgical procedures. There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Alzheimer's disease: Preliminary research suggests that TENS may benefit some symptoms of Alzheimer's disease, including mood, memory, and cycles of daily rest and activity. Additional human study is necessary before a firm conclusion can be drawn.
Grade: C

Angina (chest pain): Several small, brief studies report benefits of TENS on angina pectoris pain. However, most studies were conducted during the late 1980s and early 1990s, and were not well designed or reported. New drugs for heart disease have been developed since these studies were conducted, and people with heart disease or chest pain are advised to seek immediate medical attention from a licensed physician.
Grade: C

Ankylosing spondylitis: There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Back pain: The effects of TENS or acupuncture-like TENS on low back pain remain controversial, and multiple controlled trials have been published in this area. Studies have not been consistent in the type of TENS techniques used (location, intensity, frequency, duration) or in definitions of back pain, and most trials have not been well designed or reported. Published meta-analyses have grouped some of these studies together to try to determine whether this technique is effective, but have also yielded inconsistent results, with some authors reporting overall benefits, and others finding no clear advantage over placebo. Better-designed research is needed before a firm conclusion can be reached.
Grade: C

Burn pain: There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Cancer pain: There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Chronic pain: The effect of TENS on chronic pain of various causes and locations remains controversial, and multiple controlled trials have been published in this area. Although numerous studies report benefits, studies have overall been small, poorly designed, and without clear descriptions of results. Better-designed research is needed before a firm conclusion can be reached.
Grade: C

Dysmenorrhea (painful menstruation): TENS has been examined for the treatment of dysmenorrhea in several small studies. Research in this area suggests that the use of TENS may reduce short-term discomfort and need for pain medications. However, the available trials do not clearly describe study designs or results. Most outcomes are not measured using validated scales. Overall, blinding, randomization, dropouts, and statistical analysis are not well described. Sample sizes are small. Therefore, the research in this area remains indeterminate.
Grade: C

Headache: Preliminary controlled trials suggest that TENS may have some benefits in patients with migraine or chronic headache. Additional well-designed research is necessary before a firm conclusion can be reached in this area.
Grade: C

Hemiplegia / hemiparesis: There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Labor pain: The effect of TENS on labor pain remains controversial, and multiple controlled trials have been published in this area. Although some research reports small benefits, including reduced need for pain medications, studies have overall been small, poorly designed, and without clear descriptions of results. Better-designed research is needed before a firm conclusion can be reached. It is not clear if passage of electricity using TENS has harmful effects on the fetus.
Grade: C

Local anesthesia during gallstone lithotripsy: TENS has been tested for its effects on pain control during lithotripsy (a technique used to break up gallstones). Currently, there is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Facial pain / trigeminal neuralgia: Several studies report benefits of TENS in patients with chronic facial pain of various causes. However, these trials have been small without clear descriptions of design or results. Therefore, additional research is needed before a firm conclusion can be drawn in this area.
Grade: C

Myofascial pain: There is preliminary data that high frequency/high intensity TENS may benefit myofascial pain. However, currently there is insufficient evidence from well-designed controlled trials to support this use.
Grade: C

Nausea/vomiting of pregnancy: There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Neck and shoulder pain: There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Pain from broken bones / acute trauma: There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Peripheral neuropathy: Several case reports and a small number of controlled trials report improvements in pain symptoms in people with peripheral neuropathy or nerve damage. However, these studies have not been well designed or reported, and additional research is needed before a firm conclusion can be drawn about effectiveness.
Grade: C

Phantom limb pain: There is not enough reliable evidence to draw a firm conclusion in this area. Promising preliminary research requires confirmation with better quality studies.
Grade: C

Post-herpetic neuralgia: TENS has been used in post-herpetic neuralgia, however there is insufficient evidence from controlled clinical trials upon which to base recommendations.
Grade: C

Post-operative ileus: There is conflicting evidence from clinical trials on the effectiveness of TENS in post-operative ileus. Well-designed, large studies are needed before a recommendation can be made.
Grade: C

Post-operative nausea / vomiting: There is not enough reliable scientific evidence to firmly conclude if TENS is beneficial in patients with pain after surgery.
Grade: C

Post-operative pain: There are multiple controlled studies of TENS for pain following various types of surgery, including abdominal surgery, heart surgery, lung surgery, gynecologic surgery, and orthopedic surgery. Research is inconsistent, with a variety of TENS techniques, patient types, and study designs used. Overall, the quality of available research is poor. Although some studies do report improvements in pain and reduced need for pain medications, a well-designed review in 1996 concluded that there is no clear evidence of benefit. Better quality research is necessary in this area before a strong conclusion can be reached.
Grade: C

Post-stroke rehabilitation: Studies of TENS in post-stroke rehabilitation report inconsistent findings, and benefits have not consistently been demonstrated. Additional research is necessary before a clear conclusion can be reached.
Grade: C

Rheumatoid arthritis : Preliminary studies of TENS in rheumatoid arthritis report improvements in joint function and pain. However, most research is not well designed or reported, and better studies are necessary before a clear conclusion can be reached.
Grade: C

Skin flap ischemia: TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. Currently, there is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Skin ulcer: TENS has been evaluated in patients with diabetic foot ulcers and chronic ulcers of other causes. There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

Spinal cord injury : There have been limited non-controlled trials of TENS in spinal cord injury. Well-designed controlled trials are required to recommend for or against the use of TENS for this indication.
Grade: C

Temporomandibular joint pain (TMJ): There is insufficient reliable evidence to recommend for or against the use of TENS in temporomandibular joint pain.
Grade: C

Urinary incontinence / detrusor instability: There is not enough reliable evidence to draw a firm conclusion in this area.
Grade: C

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