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Open Access 22-11-2023

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

Authors: Leslie Verville, Cesar A. Hincapié, Danielle Southerst, Hainan Yu, André Bussières, Douglas P. Gross, Paulo Pereira, Silvano Mior, Andrea C. Tricco, Christine Cedraschi, Ginny Brunton, Margareta Nordin, Gaelan Connell, Heather M. Shearer, Jessica J. Wong, Léonie Hofstetter, Andrew Romanelli, Brett Guist, Daphne To, Kent Stuber, Sophia da Silva-Oolup, Maja Stupar, Danny Myrtos, Joyce G.B. Lee, Astrid DeSouza, Javier Muñoz Laguna, Kent Murnaghan, Carol Cancelliere

Published in: Journal of Occupational Rehabilitation | Issue 4/2023

Abstract

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.

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Wright A, Sluka KA. Nonpharmacological treatments for musculoskeletal pain. Clin J Pain. 2001;17(1):33–46.CrossRefPubMed

Shimoji K, Takahashi N, Nishio Y, Koyanagi M, Aida S. 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. Neuromodulation. 2007;10(1):42–51.CrossRefPubMed

Verville L, Hincapié CA, Southerst D, Yu H, Bussières A, Gross DP, et al. 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. J Occup Rehabil. 2023. https://doi.org/10.1007/s10926-023-10121-7.

Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev. 2008(4):CD003008.

Resende L, Merriwether E, Rampazo EP, Dailey D, Embree J, Deberg J, et al. Meta-analysis of transcutaneous electrical nerve stimulation for relief of spinal pain. Eur J Pain. 2018;22(4):663–78.CrossRefPubMed

Cancelliere C, Verville L, Southerst D, Yu H, Hayden JA, Ogilvie R, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedra[1]schi C, Brunton G, Nordin M, Wong JJ, Shearer HM, Connell G, Hincapié CA. Systematic review procedures for the World Health Organization (WHO) evidence syntheses on benefts 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. J Occup Rehabil. 2023. https://doi.org/10.1007/s10926-023-10156-w.

Herbert RD. How to estimate treatment effects from reports of clinical trials. I: continuous outcomes. Aust J Physiother. 2000;46(3):229–35.CrossRefPubMed

Herbert RD. How to estimate treatment effects from reports of clinical trials. II: dichotomous outcomes. Aust J Physiother. 2000;46(4):309–13.CrossRefPubMed

Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. 2012(9):CD008880.

10.

Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105–21.CrossRefPubMed

11.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New Jersey (NJ): Lawrence Erlbaum Associates; 1988.

12.

Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefPubMedPubMedCentral

13.

Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, et al. 2015 updated method guideline for systematic reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976). 2015;40(21):1660–73.CrossRefPubMed

14.

Hayden JA, Group BEC-CRW. Commentary: collaborative systematic review may produce and share high-quality, comparative evidence more efficiently. J Clin Epidemiol. 2022;152:288–94.CrossRefPubMed

15.

DistillerSR. Version 2023.2.1. 2023.2.1 ed. Ottawa, Canada: DistillerSR; 2023.

16.

Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.CrossRefPubMedPubMedCentral

17.

Schünemann HJ, Higgins JPT, Vist GE, Glasziou P, Akl EA, Skoetz N et al. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. 2022 [cited January 5, 2022]. In: Cochrane Handbook for Systematic Reviews of Interventions version 63 (updated February 2022) [Internet]. Cochrane, [cited January 5, 2022]. Available from: www.training.cochrane.org/handbook.

18.

R Core Team. A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna; 2022.

19.

Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softwe. 2010;36(3):1–48.

20.

GRADEpro GDT. GRADEpro Guideline Development Tool (Software]. McMaster University and Evidence Prime; 2021.

21.

Alizadeh MH, Ahmadizad S. A comparison of exercise therapy and transcutaneous electrical nerve stimulation for the treatment of chronic low back pain. World J Sport Sci. 2009;2(1):43–7.

22.

Bloodworth DM, Nguyen BN, Garver W, Moss F, Pedroza C, Tran T, et al. Comparison of stochastic vs. conventional transcutaneous electrical stimulation for pain modulation in patients with electromyographically documented radiculopathy. Am J Phys Med Rehabil. 2004;83(8):584–91.CrossRefPubMed

23.

Cheing GL, Hui-Chan CW. Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain. Arch Phys Med Rehabil. 1999;80(3):305–12.CrossRefPubMed

24.

de Alencar Caldas VV, Maciel DG, Cerqueira MS, Barboza JAM, Neto JBV, Dantas G, et al. Effect of pain education, cryotherapy, and transcutaneous electrical nerve stimulation on the pain, functional capacity, and quality of life in patients with nonspecific chronic low back pain: a single-blind randomized controlled trial. Am J Phys Med Rehabil. 2021;100(3):243–9.CrossRef

25.

Depaoli Lemos VJ, Selau RC, Blos C, Baptista Dohnert M, Boff Daitx R, de Almeida Brito V. Electroacupuncture and transcutaneous electrical nerve stimulation in chronic nonspecific low back pain: a blind randomized clinical trial. Muscles, ligaments. tendons J. 2021;11(4):719–27.

26.

Dias LV, Cordeiro MA, Schmidt de Sales R, Bieberbach Rodrigues dos Santos MM, Korelo RIG, Said Vojciechowski A, et al. Immediate analgesic effect of transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) on chronic low back pain: randomised placebo-controlled trial. J Bodyw Mov Ther. 2021;27:181–90.CrossRefPubMed

27.

Elserty N, Kattabei O, Elhafez H. Effect of fixed versus adjusted transcutaneous electrical nerve stimulation amplitude on chronic mechanical low back pain. J Altern Complement Med. 2016;22(7):557–62.CrossRefPubMed

28.

Ezema CI, Onyeso OK, Nna EO, Awosoga OA, Odole AC, Kalu ME et al. Transcutaneous electrical nerve stimulation effects on pain-intensity and endogenous opioids levels among chronic low-back pain patients: a randomised controlled trial. J Back Musculoskelet Rehabil. 2022.

29.

Jamison RN, Wan L, Edwards RR, Mei A, Ross EL. Outcome of a high-frequency transcutaneous electrical nerve stimulator (hfTENS) device for low back pain: a randomized controlled trial. Pain Pract. 2019;19(5):466–75.CrossRefPubMed

30.

Kibar S, Konak HE, Ay S, Doganay Erdogan B, Evcik D. The effectiveness of combined transcutaneous electrical nerve stimulation and interferential current therapy on chronic low back pain: a randomized, double-blind, sham-controlled study. Fiziksel Tip ve Rehabilitasyon Bilimleri Dergisi [J Phys Med Rehabil Sci]. 2020;23(1):32–40.CrossRef

31.

Kofotolis ND, Vlachopoulos SP, Kellis E. Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain. Clin Rehabil. 2008;22(2):99–111.CrossRefPubMed

32.

Petrofsky J, Laymon M, Lee H. The effect of transcutaneous electrical nerve stimulation and low-level continuous heat on non-specific low back pain: a randomized controlled trial. Gazz Med Ital. 2020;179(6):419–27.

33.

Tella BA, Oghumu SN, Gbiri CAO. Efficacy of transcutaneous electrical nerve stimulation and interferential current on tactile acuity of individuals with nonspecific chronic low back pain. Neuromodulation 2021 Aug 17:Epub ahead of print. 2021.

34.

Topuz O, Ozfidan E, Ozgen M, Ardic F. Efficacy of transcutaneous electrical nerve stimulation and percutaneous neuromodulation therapy in chronic low back pain. J Back Musculoskelet Rehabil. 2004;17:127–33.CrossRef

35.

Yaksi E, Ketenci A, Baslo MB, Orhan EK. Does transcutaneous electrical nerve stimulation affect pain, neuropathic pain, and sympathetic skin responses in the treatment of chronic low back pain? A randomized, placebo-controlled study. Korean J Pain. 2021;34(2):217–28.CrossRefPubMedPubMedCentral

36.

World Bank Country and Lending Groups. [cited 2022 May 1, 2022]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.

37.

Viswanathan M, Patnode C, Berkman ND, Bass EB, Chang S, Hartling L et al. Assessing the risk of bias in systematic reviews of health care interventions. Methods guide for comparative effectiveness reviews. (Prepared by the Scientific Resource Center under Contract No. 290-2012-0004-C)December 2017 March 20, 2023 [cited 2023 March 20, 2023]; AHRQ Publication No. 17(18)-EHC036-EF. Available from: Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCMETHGUIDE2.

38.

Hopewell S, McDonald S, Clark MJ, Egger M. Grey literature in meta-analyses of randomized trials of health care interventions. Cochrane Database Syst Rev. 2007(2):Art. No.: MR000010.

39.

Hartling L, Featherstone R, Nuspl M, Shave K, Dryden DM, Vandermeer B. Grey literature in systematic reviews: a cross-sectional study of the contribution of non-english reports, unpublished studies and dissertations to the results of meta-analyses in child-relevant reviews. BMC Med Res Methodol. 2017;17(1):64.CrossRefPubMedPubMedCentral

40.

Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. N Engl J Med. 1990;322(23):1627–34.CrossRefPubMed

Title: 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
Authors: Leslie Verville
Cesar A. Hincapié
Danielle Southerst
Hainan Yu
André Bussières
Douglas P. Gross
Paulo Pereira
Silvano Mior
Andrea C. Tricco
Christine Cedraschi
Ginny Brunton
Margareta Nordin
Gaelan Connell
Heather M. Shearer
Jessica J. Wong
Léonie Hofstetter
Andrew Romanelli
Brett Guist
Daphne To
Kent Stuber
Sophia da Silva-Oolup
Maja Stupar
Danny Myrtos
Joyce G.B. Lee
Astrid DeSouza
Javier Muñoz Laguna
Kent Murnaghan
Carol Cancelliere
Publication date: 22-11-2023
Publisher: Springer US
Published in: Journal of Occupational Rehabilitation / Issue 4/2023
Print ISSN: 1053-0487
Electronic ISSN: 1573-3688
DOI: https://doi.org/10.1007/s10926-023-10121-7

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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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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