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TENS ineffective in chronic low back pain

Clinical Question:
Is transcutaneous electrical nerve stimulation effective in treating patients with chronic low back pain or painful diabetic neuropathy?

Bottom Line:
If these authors have identified all the relevant studies, the data on transcutaneous electrical nerve stimulation (TENS) in the treatment of chronic back pain or painful neuropathy are fairly limited and more studies with high methodologic rigor are warranted. Based on the available literature, 2 high-quality studies failed to show TENS to be superior to sham TENS or other therapies in treating chronic back pain. The authors found no high-quality studies of TENS in painful neuropathy. (LOE = 2a-)

Reference:
Dubinsky RM, Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010;74(2):173-176.  [PMID:20042705]

Study Design:
Meta-analysis (randomized controlled trials)

Setting:
Various (meta-analysis)

Synopsis:
The authors based this guideline on a systematic review of clinical trials identified in MEDLINE and the Cochrane Library. To be included, the studies had to compare transcutaneous electrical nerve stimulation (TENS) with a control therapy (placebo or other therapy) in treating painful neurologic disorders. They don't describe searching for unpublished studies, whether they used independent reviewers to determine study inclusion, or how they assessed methodologic quality of the included studies. Two reviewers independently assigned a level of evidence for each recommendation and conflicts were reconciled by consensus. A total of 9 studies were included. In the treatment of low back pain, they identified 2 high-quality studies and 3 mediocre studies. The 2 high-quality studies compared TENS with sham TENS, and both failed to show that TENS is superior. One of the mediocre studies found no clinically meaningful improvements in pain scores, while 2 of the mediocre studies showed improvements in pain scores. The authors found 3 studies using TENS in the treatment of painful diabetic neuropathy, none of which were of high methodologic quality. Despite the tendency for studies with poor methods to favor interventions, the authors conclude that TENS probably confers modest benefit in pain relief from neuropathy. They also point out that no studies compared TENS with other active treatments. The authors disclosed financial support from several pharmaceutical companies and device manufacturers.

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