Abstract

Background

This is the first update of a Cochrane review published in Issue 5, 2010 on transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Pain may present in a body part that has been amputated (phantom pain) or at the site of amputation (stump pain), or both. Phantom pain and stump pain are complex and multidimensional and the underlying pathophysiology remains unclear. The condition remains a severe burden for those who are affected by it. The mainstay treatments are predominately pharmacological, with increasing acknowledgement of the need for non‐drug interventions. TENS has been recommended as a treatment option but there has been no systematic review of available evidence. Hence, the effectiveness of TENS for phantom pain and stump pain is currently unknown.

Objectives

To assess the analgesic effectiveness of TENS for the treatment of phantom pain and stump pain following amputation in adults.

Search methods

For the original version of the review we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, PEDRO and SPORTDiscus (February 2010). For this update, we searched the same databases for relevant randomised controlled trials (RCTs) from 2010 to 25 March 2015.

Selection criteria

We only included RCTs investigating the use of TENS for the management of phantom pain and stump pain following an amputation in adults.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. We planned that where available and appropriate, data from outcome measures were to be pooled and presented as an overall estimate of the effectiveness of TENS.

Main results

In the original review there were no RCTs that examined the effectiveness of TENS for the treatment of phantom pain and stump pain in adults. For this update, we did not identify any additional RCTs for inclusion.

Authors' conclusions

There were no RCTs to judge the effectiveness of TENS for the management of phantom pain and stump pain. The published literature on TENS for phantom pain and stump pain lacks the methodological rigour and robust reporting needed to confidently assess its effectiveness. Further RCT evidence is required before an assessment can be made. Since publication of the original version of this review, we have found no new studies and our conclusions remain unchanged.

Author(s)

Mark I Johnson, Matthew R Mulvey, Anne-Marie Bagnall

Abstract

Plain language summary

Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults

Pain may present in a body part that has been amputated (phantom pain) or at the site of amputation (stump pain), or both. Phantom pain and stump pain are complex conditions and affect up to 80% of amputees.The underlying causes are not fully understood. Drug therapy is the most common treatment yet the condition remains poorly managed. The need for non‐drug interventions has been recognised and TENS may have an important role to play.

TENS is an inexpensive, safe and easy to use analgesic technique. TENS is administered using a battery‐powered portable device, which generates electrical currents that are delivered to the skin to activate underlying nerves.

An updated search of various databases in March 2015 found no studies that met the eligibility criteria for inclusion in this review.

It was not possible to judge the effectiveness of TENS for phantom pain and stump pain.

It was not possible to assess the risk of harm from using TENS for phantom pain and stump pain.

A large, multicentre randomised controlled trial of TENS for phantom pain and stump pain is needed.

Author(s)

Mark I Johnson, Matthew R Mulvey, Anne-Marie Bagnall

Reviewer's Conclusions

Authors' conclusions 

Implications for practice 

Since publication of the original version of this review, we have found no new trials. There is insufficient evidence from RCTs to judge whether TENS should, or should not, be used in the management of phantom pain and stump pain in adults.

Implications for research 

A large, multicentre, adequately powered, randomised, placebo‐controlled trial with appropriate procedures for sequence generation, allocation concealment and blinding is needed. Data provided in the reports of the excluded studies may prove useful in calculating sample size. Future studies need to ensure that TENS is delivered at a strong, non‐painful intensity within or close to the site of pain (Bjordal 2003), using an appropriate technique in line with best practice (Johnson 2014). Pain outcomes should be measured whilst the TENS device is switched on, rather than before and after TENS, and the duration and frequency of each treatment recorded when TENS is used at home. Means and standard deviations for continuous data should be reported as standard to enable data extraction for subsequent meta‐analysis.

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