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Meta-Analysis
. 2018 May;43(4):425-433.
doi: 10.1097/AAP.0000000000000740.

Literature Review and Meta-Analysis of Transcutaneous Electrical Nerve Stimulation in Treating Chronic Back Pain

Free PMC article
Meta-Analysis

Literature Review and Meta-Analysis of Transcutaneous Electrical Nerve Stimulation in Treating Chronic Back Pain

Lien-Chen Wu et al. Reg Anesth Pain Med. .
Free PMC article

Abstract

Background and objectives: This study is a meta-analysis of randomized controlled trials comparing the efficacy of transcutaneous electrical nerve stimulation (TENS) to a control and to other nerve stimulation therapies (NSTs) for the treatment of chronic back pain.

Methods: Citations were identified in MEDLINE, the Cochrane Library, Google Scholar, and ClinicalTrials.gov through June 2014 using the following keywords: nerve stimulation therapy, transcutaneous electrical nerve stimulation, back pain, chronic pain. Control treatments included sham, placebo, or medication only. Other NSTs included electroacupuncture, percutaneous electrical nerve stimulation, and percutaneous neuromodulation therapy.

Results: Twelve randomized controlled trials including 700 patients were included in the analysis. The efficacy of TENS was similar to that of control treatment for providing pain relief (standardized difference in means [SDM] = -0.20; 95% confidence interval [CI], -0.58 to 0.18; P = 0.293). Other types of NSTs were more effective than TENS in providing pain relief (SDM = 0.86; 95% CI, 0.15-1.57; P = 0.017). Transcutaneous electrical nerve stimulation was more effective than control treatment in improving functional disability only in patients with follow-up of less than 6 weeks (SDM = -1.24; 95% CI, -1.83 to -0.65; P < 0.001). There was no difference in functional disability outcomes between TENS and other NSTs.

Conclusions: These results suggest that TENS does not improve symptoms of lower back pain, but may offer short-term improvement of functional disability.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Meta-analysis of pain relief. Forest plot comparing the difference in pain relief between patients who underwent treatment with (A) TENS or a control or (B) TENS or another NST.
FIGURE 2
FIGURE 2
Meta-analysis of disability level. Forest plot comparing the change in disability level between patients who underwent treatment with (A) TENS or a control or (B) TENS or another NST.
FIGURE 3
FIGURE 3
Quality assessment results. The green circles indicate lack of bias; red circles indicate the presence of bias. A, Risk of bias for each included study. The studies were assessed for 5 types of bias and for the use of an intent-to-treat analysis. B, The overall summary of bias of the 16 studies.

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