Transcutaneous Electrical Nerve Stimulation (Tens) and Pain Management

Canadian Coordinating Office for Health Technology Assessment
Office Canadien de Coordination de l'Évaluation des Technologies de la Santé
TRANSCUTANEOUS
ELECTRICAL NERVE
STIMULATION (TENS)
and
PAIN MANAGEMENT
April 1995
PROJECT DIRECTOR
JANIS REEVE
RESEARCH ASSISTANT
PAULA CORABIAN
Canadian Coordinating Office for Health Technology Assessment
Office Canadien de Coordination de l'Évaluation des Technologies de la Santé
TRANSCUTANEOUS ELECTRICAL NERVE

STIMULATION (TENS)
AND
PAIN MANAGEMENT
PROJECT DIRECTOR
JANIS REEVE
RESEARCH ASSISTANT
PAULA CORABIAN
April 1995
110-955 Green Valley Crescent

Ottawa, Ontario K2C 3V4
Telephone (613) 226-2553 Téléphone
Facsimile (613) 226-5392 Télécopieur
Additional copies of Transcutaneous Electrical Nerve
Stimulation (TENS) and Pain Management are
available from CCOHTA.
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purposes is permitted provided appropriate credit
is given to CCOHTA.
Legal Deposit - 1995

National Library of Canada
ISBN 1-895561-26-4
CCOHTA
REVIEWERS
Dr. J. D. Cassidy Assistant Professor of Orthopaedics

Department of Orthopaedics
Two earlier drafts of this University of Saskatchewan
report were reviewed by Saskatoon, Saskatchewan
members of CCOHTA's
Scientific Advisory Panel,
Dr. A.M. Fargas-Babjak Associate Professor
and the Board of
Directors. The Director, Acupuncture/Pain Clinic
individuals listed here Department of Anaesthesia
were also kind enough to McMaster University
provide comments on a Hamilton, Ontario
draft. This final
document incorporated
most of the Reviewers' Dr. M. E. Jeans Director General
comments, however, the National Health Research &
authors take sole Development Program
responsibility for its form Health Canada
and content.
Ottawa, Ontario
Dr. H. Hall Consulting Orthopaedic Surgeon

Canadian Back Institute
Toronto, Ontario
CCOHTA
EXECUTIVE SUMMARY
This report is the result of a study conducted by CCOHTA to assess the effectiveness and cost-
effectiveness of transcutaneous electrical nerve stimulation (TENS) used in its various applications, to
determine TENS utilization in Canadian hospitals, and methods of payment for TENS services across
Canada.
The use of TENS for the management of pain began in the mid-1960s and was based on the "gate
control theory" that suggests pain impulses to the brain may be blocked or interrupted by the
stimulation of nerve fibres. A TENS unit consists of an electronic stimulus generator and electrodes
which are placed directly on the skin. It has been reported that this technology is effective in
controlling pain in a number of applications and thus has been adopted by many health professionals.
In Canada, TENS is usually provided by physiotherapists, in hospitals and clinics. No major adverse
effects have been reported with the use of TENS.
To determine the effectiveness of TENS, a total of 55 clinical studies of TENS for acute pain, chronic
pain and labour and delivery were reviewed independently by two reviewers. The studies were rated
and ranked on the basis of two sets of previously published quality criteria and information was
gathered in the areas of participants' characteristics, intervention/comparison groups' characteristics
and outcomes. As well, to determine the methods of payment and the utilization of TENS in Canada,
two surveys were developed. The first survey was sent to Ministries of Health of the twelve provincial
and territorial Ministries of Health and the second survey was sent to a stratified sample of 50 public
general hospitals with more than 200 beds.
According to the critical appraisal of the literature, published evidence is equivocal in acute pain
treatment and there is little evidence of the effectiveness of TENS in treating chronic pain. The bulk
of evidence in labour and delivery indicates that TENS is not effective; however, there is a strong
component of patient satisfaction. There are no cost-effectiveness data published to date. There is a
need for rigorous prospective evaluations of TENS.
Regarding reimbursement by provinces and territorial governments for TENS services, the survey
reveals wide variations. Physicians are paid either for TENS services specifically or for bundles of
services including TENS. Other health professionals are also paid, in various ways, for TENS
services. The hospital survey indicates that TENS is administered predominantly by
physiotherapists and actual utilization rates vary greatly from hospital to hospital as well as by
application. The most frequent use, however, is for managing chronic pain.
CCOHTA
CONTENTS
I. INTRODUCTION .................................................... 1
II. TENS - The Technology ..................................... 2
IV. RESULTS - Effectiveness ................................. 6
V. RESULTS - Utilization & Payment......... 9
Table 2 Reimbursement Schemes ............................................... 10
Table 3 Summary of Results of the Survey of Canadian Hospitals 11
VI. DISCUSSION/CONCLUSIONS .............. 11

APPENDIX 1......................................................................................... 15
REFERENCES ..................................................................................... 29
LIST OF TABLES
Table 1 Sample Size ..................................................................... 6
Table 2 Reimbursement Schemes ........................................... 11
Table 3 Summary of the Results of the Survey

of Canadian Hospitals ......................................................................... 12
CCOHTA
I. INTRODUCTION
Transcutaneous electrical nerve stimulation (TENS) is a therapeutic modality that is intended to
reduce pain perception in a number of clinical conditions. Since the early 1970s, TENS has come into
wide use as a non-invasive alternative for managing both acute and chronic pain. In Canada, it is
being used in diverse settings, and by various health care practitioners, including doctors, nurses and
physiotherapists. Ambulatory units are also available which are worn and operated by patients.
CCOHTA was directed by a provincial government to undertake a study of TENS. The study was to
include:
(a) a review of the effectiveness and cost-effectiveness of TENS used in its various applications, and
(b) a determination of TENS utilization patterns (if any) across Canada, and of methods of payment for
TENS by provincial and territorial governments.
This report begins with a description of TENS technology and of its potential applications (Section II).
In Section III, the methods used in this s tudy are described. The results are contained in Section IV
(of effectiveness and cost-effectiveness) and Section V (of utilization and payment schemes). The
study conclusions are in Section VI.
II. TENS - The Technology
Clinical interest in the use of electric current to control and treat pain has existed for many years, but
a new era of electrical nerve stimulation began in the mid-1960s when the "gate control theory" of
pain control was developed (Melzack & Wall, 1965; Kahn, 1994). According to this theory, selective
stimulation of certain nerve fibres could block (or "close the gate" on) signals carrying the pain
impulse to the brain.
TENS units usually have a single channel (with two electrodes) or dual channels (with four
electrodes). An electronic stimulus generator transmits pulses to the electrodes which are placed
directly on the skin. The pulse forms can be exclusively positive or negative (monophasic) or bipolar
(biphasic), and are of various shapes. The number of impulses transmitted to the skin (the
frequency) can be controlled.
Generally in TENS therapy, frequencies in the 80 to 120 cycles per second range are considered
"high" and usually applied for acute pain. Frequencies of 1 to 20 cycles per s econd are considered
"low" and used in treating chronic pain. Pulse width or duration, measured in microseconds, is the
time the current acts on the patient during each pulse, and is usually between 50 and 400
microseconds. The final variable is intensity or amplitude of the current; most TENS units range
from 1 to 100 mA. It is also possible to modulate (i.e. intermittently change) frequency, pulse width
and amplitude.
Since the TENS device first appeared in the health care field, the basic design has not undergone any
fundamental changes. For example, although there is more of an understanding of the nervous
system and its involvement in the perception of pain today than there was in the 1960s, very little
research has been done on the placement of electrodes and aspects of the electrical stimulus such as
frequency and pulse width. Regardless, the field has grown and now includes many manufacturers
and multiple brands and models. Portable battery-powered TENS units, worn on a belt or carried in
the pocket, are commercially available.
Initial reports comparing TENS with narcotic drugs in managing pain indicated that pain of different
etiologies and of different types was reduced or even eliminated with TENS. The technology quickly
became known to many types of health professionals who began to adopt it. Various reports have
since claimed that the proper use of TENS is effective in a number of applications. Reported
applications of TENS have included pre- and post-operative pain, post-traumatic acute pain,
musculoskeletal problems, chronic pain, obstetrical labour and delivery, dental pain, fracture pain
and healing, tinnitus, and a multitude of pediatric pain applications.
No major hazards have been reported with TENS therapy. Minor side effects include possible skin
irritation at the electrode site. Caution is recommended in the use of TENS on patients taking
narcotic medication and it is recommended that electrodes not be placed close to the carotid sinus,
over the eyes, open wounds, irritated skin, or internally. TENS units may inhibit or interfere with the
operation of demand-mode cardiac pacemakers and also may cause interference during cardiac and
fetal monitoring.
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CCOHTA
III. METHODOLOGY
Literature Search
A literature search was conducted on the following databases:
1. MEDLINE: from 1985 to March 1994;

2. Health Planning & Administration: from 1975 to March 1994;
3. Nursing & Allied Health: from 1983 to December 1993;
4. EMBASE: from 1974 to March 1994;
5. HSTAR: from 1985 to March 1994.
The term "transcutaneous electric nerve stimulation" was applied as a MeSH heading; other key
words used included:
$ "transcutaneous electric nerve stimulation" in the title or as a descriptor;

$ "TENS" in the title;
$ "electrical stimulation" as a descriptor;
$ "trial", "review", "meta", "analysis", "pregnancy" or "pain" in the title or descriptor.
The search was restricted to studies of human subjects.
Sixty-three English-language articles were identified; of these, it was determined that 19 were
irrelevant to this assessment, and 44 articles were retrieved. Two of the articles retrieved related to
the application of TENS in tinnitus; however, these were not included in the analysis.
For further references relating to labour pain, the "Pregnancy and Childbirth" database of the
Cochrane Database of Systematic Reviews (Howell, 1993) was consulted and six articles were
identified and retrieved. A text on electrotherapy identified one secondary reference which was
retrieved as well (Kahn, 1994).
One further source of literature was Critical Literature Review: Clinical Effectiveness in Allied
Health Practices (Barr, 1993) from the Agency for Health Care Policy and Research. Although eight
articles were retrieved, only four were reviewed. Those articles not reviewed were excluded because
they did not report on TENS trials.
In total, the 53 articles described 55 studies. They were divided into the categories of acute, chronic
and labour pain; they were reviewed by two reviewers independently, collecting information in the
areas of participants' characteristics, intervention/comparison groups' characteristics, and outcomes.
The quality of the literature was established using the grades of quality of evidence published by the
Canadian Task Force on the Periodic Health Examination (Goldbloom & Battista, 1988). This
scheme has three classes, from Grade I (high quality) to Grade III (poor quality). The criteria for the
grades are:
I: Randomized controlled trials;

II: Non-randomized, well-designed controlled trials, cohort or case-control studies, comparisons
between times or places with or without the intervention;
III: Expert opinion, descriptive studies.
Grade I studies were further assessed by a modified version of Chalmers et al. (1981) system to
evaluate various quality items. The revised scale consisted of Chalmers' criteria for evaluating study
design only, and was comprised of items addressing the selection and description of subjects,
withdrawals and reasons for withdrawals, definition of therapeutic regime, presence of a placebo,
blinding, randomization, compliance, and outcome measures. In addition, the scale was revised to
include the items of inclusion and exclusion criteria and a requirement for the procedure of
administering TENS and the placebo to be identical. An item which referred to the blinding of
physicians and patients to the ongoing outcomes of the study was removed because there was not
enough information provided in the articles reviewed to fully evaluate it. In total the system had 16
items, each assigned a numerical score according to its importance in ensuring a trial of high quality.
The maximum score obtainable was 60 points.
To verify the validity of Chalmers et al. (1981) system, all articles were also independently scored by
two reviewers. The reviewers then combined their results, and discussed any areas of discrepancy.
If the reviewers were unable to reconcile their differences, a third reviewer was called in to
adjudicate. This adjudication step was required for two studies of the fifty-two.
Summary tables describing participants' characteristics, intervention/ comparison groups'

characteristics, outcome measures, and results for all studies reviewed may be found in Appendix 1.
The scores obtained by Grade I studies on the modified Chalmers et al. (1981) system are also
included in the appropriate tables.
Cost Data
Information on prices of TENS units was obtained from the manufacturers.
Survey Methodology
Survey of Provinces/Territories
In order to determine the status of TENS as a reimbursable procedure in Canada, a questionnaire

survey was used. The questionnaire sought information on the types of health professionals who
administer TENS and where it is administered, and information on TENS reimbursement by public
medical insurance plans in 1993-1994. The questionnaire was sent to Ministries of Health of the
twelve provincial and territorial governments.
Survey of Canadian Hospitals
To determine how TENS is actually being used in hospitals, a second questionnaire survey was
conducted. Information sought included the availability of TENS as a treatment, the applications for
which TENS is being used, the health professionals providing it, and an indication of how often
TENS is used in its various applications.
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CCOHTA
Table 1 Sample Size
The study population comprised
public general hospitals with more
Number of Percentage of than 200 beds. The sample of 50
Province hospitals with Sample sample to hospitals was derived through the
200+ beds population use of the Canadian Hospital
British Columbia 25 6 24%
Association's "1993-1994 Guide to
Canadian Health Care Facilities".
Alberta 13 3 23
The sample was stratified by
Saskatchewan 9 2 22 province and territory according to
Manitoba 7 2 29 population (see Table 1).
Ontario 70 18 26
Since the information required to
Quebec 57 14 25 complete the questionnaire could
New Brunswick 8 2 25 have required the input of many
departments in a hospital (e.g.
Nova Scotia 2 1 50
physiotherapy department, pain
Prince Edward 1 1 100 clinic) it was sent to the Chief
Island
Executive Officer/President of the
Newfoundland & 4 1 25 facility. French-language
Labrador
questionnaires were sent to the
Total 196 50 26% hospitals in the province of
Quebec.
IV. RESULTS - Effectiveness
Acute Pain (24 studies reviewed; Grade I: 19, Grade II: 5)
This review encompassed acute pain of various etiologies and origins including post-operative pain,
dysmenorrhea, dental, back and cervical pain.
Nineteen studies were of Grade I quality, 10 of which demonstrated that TENS was statistically
significantly more effective than sham-TENS and various analgesics in reducing pain, increasing
mobility, or decreasing the amount of analgesics required (Smith, Guralnick, Gelfand & Jeans,
1986; Akyuz, Kayhan, Babacan & Atalay Gener 1993; Sim, 1991; Rosenberg, Curtis & Bourque,
1978; Cooperman, Hall, Mikalacki, Hardy & Sadar 1977; Conn, Marshall, Yadav, Daly & Jaffer
1986; Rooney, Jain & Goldiner 1983; Ordog, 1987; Nordemar & Thorner, 1981; Dawood & Ramos,
1990). One article concluded that TENS decreased pain as compared to sham-TENS, however, there
was no statistical significance reported (VanderArk & McGrath, 1975). The remaining 8 of the 19
Grade I articles concluded that TENS was no more effective in reducing pain severity, length of stay,
analgesia requirements, or increasing peak expiratory flow than the comparator which was
primarily sham-TENS (Gilbert, Gledhill, Law & George, 1986; Smedley, Taube & Wastell, 1988;
Cuschieri, Morran & McArdle, 1985; Stubbing & Jellicoe, 1988; McCallum, Glynn, Moore,
Lammer & Phillips, 1988; Herman, Williams, Stratford, Fargas-Babjak & Trott, 1994; Lundeberg,
Bondesson & Lundstrom, 1985; Lewers, Clelland, Jackson, Varnet & Bergman, 1989). The scores
obtained by these studies on the modified Chalmers et al. (1981) system ranged from as low as
20.5/60 up to 50/60, however, the majority of studies tended to be in the 30/60 to 40/60 range.
Five studies were of Grade II quality. TENS was found to significantly reduce the amount of
narcotics required in three studies (Hollinger, 1986; Bussey & Jackson, 1981; Torres et al., 1992)
and in two studies TENS was found to provide no more relief than narcotic pain medications
(Issenman, Nolan, Rowley & Hobby, 1985) and not enough relief to conduct dental surgery (Hansson
& Ekblom, 1984).
Chronic Pain (19 studies; Grade I: 10, Grade II: 5, Grade III: 4)
This review encompassed chronic pain, including low back pain, pancreatitis, arthritis, angina
pectoris, and various other chronic conditions. Three studies found TENS to significantly decrease
pain or increase exercise tolerance and straight leg raising exercises when compared against
mechanical massage, sham-TENS, and no TENS (Melzack, Vetere & Finch, 1983; Mannheimer,
Carlsson, Vedin & Wilhelmsson, 1986; Fargas-Babjak, Rooney & Gerecz, 1989). One trial found the
comparator of ice massage to be more effective than TENS in relieving pain (Melzack, Jeans,
Stratford & Monks, 1980). A study by Griffin, Newsome, Stralka and Wright, (1990) found High
Voltage Pulsed Current (HVPC) to significantly reduce hand edema when compared to sham-HVPC
but found no significant difference between HVPC and intermittent pneumatic compression. The
remaining 5 studies of Grade I quality did not find TENS to be more effective than the comparators
of sham-TENS, exercise, ice massage, and electro-acupuncture (Deyo, Walsh, Martin, Schoenfeld &
Ramamurthy, 1990; Lehmann et al., 1986; Geirrson, Wang, Lindstrom & Fall, 1993; Langley,
6
CCOHTA
Sheppeard, Johnson & Wigley, 1984; Thorsteinsson, Stannington, Stillwell & Elveback, 1978). The
quality of these studies varied greatly according to the modified Chalmers et al. (1981) system. The
scores obtained ranged from 22/60 to 57/60.
Five studies provided Grade II evidence. Two studies involving patients with angina found TENS to
significantly improve maximal work capacity (p<0.01) and allow the heart rate to be paced to a
higher frequency without anginal pain (p<0.001) (Mannheimer et al., 1986). Two further studies
found TENS to have some pain relieving affects, however, there was no statistical significance in the
results (Tulgar, McGlone, Bowsher & Miles, 1991; Long, Campbell & Gucer, 1979). The final
study found TENS did not significantly reduce pain or relieve symptoms when compared to
electroacupuncture (Ballegaard, Christophersen, Dawids, Hesse & Olsen, 1985).
Within the Grade III category, four studies were reviewed. Three of these studies found TENS to be
of some benefit in relieving pain, however, one study indicated that pain relief was not achieved on a
long-term basis (Fried, Johnson & McCracken, 1984; Don & Tay, 1982; Loeser, Black &
Christman, 1975). The fourth study provided mixed results due to the mixture of various chronic
pain conditions under study (Procacci, Zoppi, Maresca & Francini, 1977).
Labour Pain (12 studies reviewed; Grade I: 8, Grade III: 4)
Of the 12 articles reviewed to determine the effectiveness of TENS in controlling pain in labour and
delivery, 8 articles were of Grade I quality. Three studies of these reported statistically significant
results and five studies had results which were non-significant. The three studies with significant
results reported that:
C when the cervix was dilated less than 7 cm, significantly more mothers in the TENS group than
the group receiving conventional pain medications reported a painful labour (p<0.001)(Erkkola,
Pikkola & Kanto, 1980)
C 93% of patients using TENS and 62% of patients using sham-TENS reported excellent to good
pain relief (p<0.01)(Hughes, Dailey & Partridge, 1988)
C the epidural was most effective providing complete relief in 88% of the patients, partial relief
was reported by 90% of those receiving Entonox, 96% of those receiving TENS, and 54% of
those receiving pethidine and promazine (p<0.001)(Harrison et al., 1987).
The five studies with non-significant results found TENS to be no more effective than the
comparator which was conventional pain medications including Entonox, and in most instances
sham-TENS (Neshiem, 1981; Harrison, Woods, Shore, Mathews & Unwin, 1986; Bundsen, Ericson,
Peterson & Thiringer, 1982; Thomas, Tyle, Webster & Neilsen, 1988; Chia, Arulkumaran, Chua &
Ratnam, 1990). As in the previous two applications of TENS, the quality of the Grade I studies
relating to labour and delivery varied widely according to the rating system (from 10.5/60 to 54/60).
In fact, the majority of studies had scores of less than 28/60 indicating that the design of these
studies was indeed quite poor. Three Grade I studies (Harrison et al., 1986; Hughes et al., 1988;
Thomas et al., 1988) also found that significantly more women using TENS than sham-TENS,
regardless of the outcome, would request to use TENS again in another labour.
Four studies reviewed were in the Grade III category. Each of these three studies found TENS to be
effective in providing pain relief during labour and also reinforced patient satisfaction with TENS
(Grim & Morey, 1985; Gowers, 1985; Keenan, Simousen & McCrann, 1985; Augustinsson, L.-E., et
al., 1977).
Cost-Effectiveness
No economic evaluation of TENS exists in the published literature. Therefore, no conclusions on

cost-effectiveness have been arrived at.
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CCOHTA
V. RESULTS - Utilization & Payment
Survey of Provinces/Territories
Utilization
All twelve provincial and territorial governments responded to the survey; TENS is available as a
treatment in all jurisdictions. Although TENS is administered by several different health
professionals, survey respondents reported that TENS was administered primarily by
physiotherapists (83.3%) and next, physicians (50%). Other professionals who administer TENS
include chiropractors (16.6%), nurses (8.3%), home care staff (8.3%) and naturopathic physicians
(8.3%). TENS was reported as being provided predominantly in private practice (83.3%) and in the
hospital setting (66.6%). In only one jurisdiction is TENS available through home care or public
health services.
Payment to Physicians
In four jurisdictions (New Brunswick, Quebec, Ontario and Saskatchewan), physician-provided

TENS is a reimbursable service under the respective provincial health insurance plan (see Table 2).
However, there are variations among the payment schemes in these four provinces, e.g. whether
TENS can be billed for specifically or under a broader category of therapeutic services. This makes
it difficult, if not impossible, to determine exactly either total number of TENS procedures provided
in a year or total payments specifically for TENS services by physicians. It is important to bear this
in mind when interpreting Table 2.
Payment to Other Categories of Health Professionals
In five jurisdictions (British Columbia, Alberta, Manitoba, Ontario, and Newfoundland), health
professionals other than physicians can bill the provincial health insurance plan for certain medical
services. For example, in all five of these provinces, chiropractors can bill the plan for certain
specified services, and in three of them (British Columbia, Alberta, and Ontario), physiotherapists
may also be paid by the plan for listed services. Some other professionals have similar
arrangements as well; podiatrists, naturopathic physicians, optometrists, and massage therapists in
British Columbia, optometrists, dentists, and oral surgeons in Manitoba, podiatrists, optometrists,
osteopaths, and dentists in Ontario, and dentists in Newfoundland. However, in no jurisdiction in
Canada can any of these categories of health professionals bill the plan specifically for TENS services
(ie. TENS is not listed as a specific code item applicable to these health professionals in any province
or territory). TENS may be included in a "bundle" of services (e.g. physiotherapy services) for
which reimbursement will be made by the health insurance plan. Consequently, the number of times
TENS is performed by non-physicians and the associated payment cannot be separated out.
Table 2 Reimbursement Schemes
Province Description of TENS-related reimbursable services Number of services and total

payments for 1993-1994
New Brunswick - Initial visit, including consultation, examination, 1 service

17 services
- Subsequent visit, visit fee included Not available
- TENS may also be billed as non-specific "visit
Quebec - Evaluation of the effectiveness of TENS in Claimed 212 times to a total

relieving pain (may be billed only by specialists, in certain clinics, up to two of $6,970.00 in 1993.
- Electrotherapies which could include TENS (may Claimed 64,600 times to a

be billed only by specialists, up to three times/session) total of $411,447.57.
- Administering TENS (may be billed by general Claimed 45,565 times for a
practitioner, up to three times/session) total of $460,326.58.
Ontario There is a general code for therapeutic procedures Not available

under which TENS may be billed.
Saskatchewan There is a code which may be billed for all 320 services were paid for at
physiotherapy modalities. $2.20 (paid at 75% with a
visit) under this code.
Costs of TENS units range from $85 to $250 (manufucturer's data). However, the total cost of usage
of TENS would include professional fees, hospital-related costs, etc. It is difficult to obtain a single
estimate of system-wide costs of TENS utilization, in part due to the varied patterns of use and
payment as illustrated in Tables 2 and 3.
Survey of Canadian Hospitals
The survey of Canadian hospitals with more than 200 beds yielded an 84% response rate (42/50).
Although 42 facilities responded, data were provided for 44 facilities as two of the survey sites
represented multi-hospital facilities. TENS is available as a treatment modality in all hospitals
responding. The number of TENS units available in hospital varies widely from 1 unit to 25 units
(average: 9). These TENS units are located mainly in physiotherapy departments (88.6%),
rehabilitation departments (13.6%), and in labour and delivery units (6.8%). Other departments
mentioned include palliative care, nursing, operating room, pain clinic, and geriatrics.
TENS, when used in hospital, is provided largely by physiotherapists (97.7%). Physicians

administer TENS in only two of the facilities in the sample (4.6%) and in each case physiotherapists
also provide TENS. Nurses provide TENS in seven facilities (16%) in three of which it is under the
direction of physiotherapists. Other health professionals who provide TENS therapy include
rehabilitation technicians (in Quebec), physiotherapist assistants, and occupational therapists.
The most common applications of TENS are for chronic pain (95.5%), and acute pain (93.2%). In
approximately 43% of the hospitals, TENS is used to control labour pain and in 36% TENS is used
for all three pain applications.
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CCOHTA
In the physiotherapy department of hospitals, the usage of TENS varies widely within applications
and between hospitals. In acute pain applications, facilities report using TENS from two times each
year up to 62 times each day. When using TENS to manage chronic pain, the number of times used
ranges from six times each year up to 29 times each day, and in managing labour pain, TENS is
being used anywhere from one time each year to once every three weeks. Nineteen physiotherapy
departments indicate that TENS is being used more for chronic pain applications than acute pain
applications, in 10 departments TENS is being used to control acute pain more than chronic pain,
and in 13 departments the number of times TENS is being used is either equal for both applications
or the difference is not available.
Information regarding the use of TENS in Pain Clinics is available for four facilities. In each case,
TENS is being used to manage only chronic pain and the range of use is from three times each year
to three times each day. In labour and delivery departments, TENS is used from two times each year
to up to four times each month. It is common for patients to bring in their own or rented TENS
machines to use during labour.
Table 3 Summary of Results of the Survey of Canadian Hospitals
Application Percentage of Approximate usage in

hospitals using physiotherapy departments
TENS
Chronic pain 95.5% 2 times/year to 62 times/day
Acute pain 93.2 6 times/year to 29 times/day
Labour pain 43.0 1 time/year to 1 time/3weeks
Acute, chronic, 36.0 --

and labour pain
VI. DISCUSSION/CONCLUSIONS
Acute Pain
The body of clinical evidence suggesting that TENS is effective is approximately equivalent to the
body of evidence that suggests it to be no more effective than sham-TENS. There were some studies
that concluded TENS was statistically significantly more effective than the comparator. However,
because the sites and origins of pain, the outcome measures, as well as the comparators themselves
varied among these studies, a quantitative meta-analysis was deemed to be inappropriate.
According to the scores obtained from a modified version of Chalmers et al. (1981) rating system, the
study design of the Grade I studies was quite mediocre in quality.
There is some difficulty in interpreting these studies because of the outcome measures used. (This is
in fact true of most studies on pain alleviation, and is not limited to TENS applications.) One of the
most common outcome measures used in the studies reviewed, particularly in those of post-operative
pain, was the requirement for analgesia. There is some question as to the appropriateness of
analgesic requirements when assessing pain (McCaffery & Beebe, 1989). Although this may be
considered to be an objective measure, it does not always accurately reflect the actual amount of pain
being experienced. It is not uncommon for patients experiencing pain to refuse pain medications
(particularly narcotics) due to fear of addiction, sedation, tolerance and loss of control. The best
measure of pain is the patient's own subjective evaluation as determined by a validated instrument
(McCaffery & Beebe, 1989).
Chronic Pain
There is very little clinical evidence of Grade I quality that supports the effectiveness of TENS in
managing chronic pain. In fact, the study with the highest score, according to the modified
Chalmers et al. (1981) rating system, concludes that TENS is no more effective than the comparator
(Deyo et al., 1990). However, even in the Grade I category, the methodological quality of studies
reviewed varied greatly. Scores of the modified Chalmers et al. (1981) criteria range from 22/60 to
57/60. Some authors failed to describe the treatment regimes in sufficient detail (e.g. stimulation
settings, treatment frequency) or to adequately describe pain-rating measures.
Labour Pain
There is only one study of Grade I quality (Hughes et al., 1988) which supports the effectiveness of
TENS in managing labour pain. In fact, a study which had a higher score using the modified
Chalmers et al. (1981) rating system concluded that TENS actually increased pain when used in
labour (Erkkola et al., 1980). The bulk of evidence indicates that TENS is not effective in reducing
labour pain. Regardless of the outcome, however, many women displayed the desire to use TENS
again in a future labour which shows some form of consumer satisfaction. Because the studies do
not show adverse effects from using TENS in labour (ie. occurrence of operative vs normal
deliveries, Apgar scores, mean cord blood pH values), TENS may be a viable option for satisfying
patients during labour and delivery. These conclusions are in agreement with those found in the
review of "Transcutaneous Nerve Stimulation (TENS) in Labour" completed by the Cochrane
Database of Systematic Reviews (Howell, 1993).
The Placebo Effect
When determining the effectiveness of any treatment, it is also important to consider the impact of
nonspecific or "placebo" treatment effects which are derived from influences such as the
expectations of both the patient and the physician and the status of the treatment (Turner, Deyo,
Loeser, Von Korff & Fordyce, 1994). This effect is based on subconscious interactions between the
patient, the doctor, and the treatment, and has been shown to work well in patients experiencing pain
(Oh, 1994).
It has been found that the more similar in nature the placebo is to the active treatment, the smaller
the difference is between the effects produced (Turner et al., 1994). Several studies in this review of
TENS used the comparator of sham-TENS as the placebo and in fact, in most of those studies, sham-
TENS was the only comparator. In order to better distinguish the difference between the specific
and placebo effects of TENS, more trials with untreated control groups are required (Gøtzsche,
1994). This would further allow for the determination of the effectiveness of TENS in managing pain
in its various applications.
12
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Utilization of TENS in Canada
TENS is being used across Canada primarily by physiotherapists to treat acute, chronic, and labour
pain. The reimbursement of this procedure varies from jurisdiction to jurisdiction, and there are no
exact figures as to the number of times TENS is performed by physicians or any other health
professional. It is also not possible to determine exactly how often TENS is used to manage pain,
although it appears that use varies greatly between hospitals and within individual hospitals for each
application. The survey indicates however, that TENS is being used most often for chronic pain
applications, for which there appears to be the least evidence of its benefit, based on the literature
reviewed. It is not possible to determine the cost-effectiveness of TENS as there are no data in the
literature. Finally, as previously mentioned, there is no precise estimation of how often TENS is
being used to control pain.
APPENDIX 1
14
CCOHTA
TENS and Acute Pain - Grade I Studies
Trial Modified Participants' Intervention/ Outcome Results

Chalmers' et al. Characteristics Comparison Groups' Measures
(1981) Score Characteristics
Smith, C.M., 36 -elective cesarean TENS (n=9) vs sham-TENS -McGill pain Patients in the TENS group reported
Guralnick, M.S., delivery (n=9) questionnaire significantly less movement-
Gelfand, M.M., -multiparous -analgesic intake associated cutaneous pain on
Jeans, M.E. 1986 -mean age 30.5 for TENS postoperative days 1 and 2.
group and 28.0 for No significant differences noted in
comparison group analgesic intake (TENS-treated
women received slightly fewer
doses).
Akyuz, G., 30 -various gynecological TENS (n=17) vs sham- -pain severity on TENS significantly decreased pain on
Kayhan, O., procedures (eg. TENS (n=13) vertical pain scale days 1, 2, and 3 postoperative.
Babacan, A., et al. abdominal hysterectomy, -analgesic intake Six patients in TENS group and all
1993 oophorectomy, tubal -postoperative patients in sham-TENS group
ligation, C-Section) paralytic ileus required analgesic drugs.
-mean age 39.2 for TENS Post-operative paralytic ileus
group and 36 for observed in 12% of TENS group and
comparison group 54% in sham-TENS group.
Sim, D.T. 1991 25 -27 females and 3 males TENS (n=15) vs -analgesic intake No significant differences in opiate
undergoing elective Papaveretum (n=15) -pain severity on analgesic requirements (Day 1 mean
cholecystectomy (right linear analogue scale for TENS group 49.0 mg and 46.67
upper paramedian -lung function mg for comparison group and day 2
incision) parameters (FVC mean 12.0 mg for TENS group and
-mean age 47.0 for TENS and FEV1) 18.0 mg for comparison group).
group and 51.8 for control TENS group had significantly lower
group rest pain and deep breathing pain on
day 2 post-op, and cough pain on day
5 post-op.
No significant difference in forced
expiratory volume (FEV1) and forced
vital capacity (FVC) between groups
(fall and rise of values almost
identical for both groups).
Rosenberg, M., 20.5 -cholecystectomy (midline TENS (n=6) vs Demerol prn -analgesic intake TENS group showed significant
Curtis, L., Bourke, upper abdominal incision) (n=6) -incidence of ileus decrease in amount narcotics
D.L. 1978 -mean age and weight of -incidence of administered day 1 & 2 post-op.
TENS group 42 years and atelectasis
TENS group 42 years and atelectasis Presence of ileus similar in both
83.9 kg -respiratory groups.
-mean age and weight of parameters (eg. One case of atelectasis in each
control group 43.2 years FVC, FEV1) group.
and 71.2 kg Respiratory parameters nearly
identical in each group.
Gilbert, J.M., 37.5 -unilateral inguinal TENS (n=20) vs sham- -pain severity on No significant difference between
Gledhill, T., Law, herniorrhaphy for the TENS (n=20) visual analogue scale groups for pain score, peak
N., et al. 1986 first time -analgesic expiratory flow, and pethidine
-ages ranged from 24-77 requirements requirements.
-expiratory peak
flow
Smedley, F., 40 -unilateral inguinal TENS (n=34) vs sham- -pain severity on No significant differences in reported
Taube, M., herniorrhaphy for the TENS (n=28) linear analogue scale pain , peak expiratory flow rates, and
Wastell, C. 1988 first times -analgesic intake analgesic requirements (0.9 doses per
-ages ranged from 21-83 -peak expiratory patient in TENS group and 0.85 doses
flow per patient in comparison group)
between groups.
Cuschieri, R.J., 36 -elective abdominal TENS (n=53) vs sham-TENS -pain severity on No significant differences between
Morran, C.G., surgery (n=53) linear analogue scale groups in reported pain (similar
McArdle, C.S. 1985 -39 male and 62 female -analgesic scores), morphine requirements (mean
patients requirements 59 mg of morphine in TENS group and
-ages ranged from 14-81 -arterial blood gas 50 mg in comparison group), and
years values arterial blood gas analysis (on
postoperative day 1 mean PaO2 for
TENS group 9.2 kPa and 9.7 kPa for
comparison group, etc.).
Cooperman, A., 34.5 -major intra-abdominal TENS (n=27) vs sham-TENS -analgesic intake 77% of patients with active TENS
Hall, B., Mikalacki, surgery with upper (n=23) received excellent (required no
K., Hardy, R., abdominal midline medicine or occasional dose of
Sadar, E. 1977 incisions diazepam) or good results (required
-26 female and 24 male diazepam and less than 3 doses of
patients Demerol every 24 hours) as compared
-ages ranging from 20 to 74 to 33% of patients with sham TENS.
years
Conn, I.G., 40 -consecutive patients TENS (n=15) vs sham-TENS -pain severity on No significant difference of reported
Marshall, A.H., undergoing emergency (n=13) vs linear analogue scale pain in TENS and sham-TENS groups,
16
CCOHTA
Marshall, A.H., undergoing emergency (n=13) vs linear analogue scale pain in TENS and sham-TENS groups,
Yadav, S.N., Daly, appendectomy papaveretum/mefenamic acid -analgesic intake however pain severity significantly
J.C., Jaffer, M., -18 male patients, 24 (n=14) greater in papaveretum/mefenamic
1986 female patients acid group.
-age range of patients 13- Papaveretum/mefenamic acid group
58 years required significantly more analgesia
than other two groups in first and
second 24 hours.
Patients in TENS group asked for
significantly less analgesia in first 24
hours than the sham-TENS group.
VanderArk, G.D., 33 -receiving abdominal or TENS (n=61) vs sham-TENS -pain severity on scale 77% of TENS group and 17% of
McGrath, K.A. 1975 thoracic procedures (n=39) of 1 to 10 sham-TENS group experienced some
(thoracic, inguinal hernia -duration of pain relief form of pain relief.
repair, cholecystectomy, -analgesic Postoperative ileus was apparent in
appendectomy, hernia requirements 18% of comparison group and 16% in
repair, vagotomy and -presence of TENS group.
antrectomy) atelectasis Atelectasis present in 5% of each
-range of ages 13-87 -presence of ileus group.
Stubbing, J.F., 23.5 -thoracotomies TENS (n=20) vs papaveretum -analgesic Mean dose of papaveretum in first 24
Jellicoe, J.A. 1988 -in TENS group mean age (n=20) requirements hours not significant (53.5 mg in TENS
54 m:f ratio 13:7, and -peak expiratory flow group and 52.5 mg in comparison
mean weight 61.3 kg rate group).
-in the group receiving -requirements for Postoperative peak expiratory flow
papaveretum mean age 53, antiemetic drugs rates comparable between groups.
m:f ratio 15:5, mean -length of hospital stay Five patients in TENS group required
weight 69.2 kg -pain severity on 0 to antiemetics and 11 in the comparison
4 scale group.
Mean length of stay in hospital not
significant (10.25 days for TENS group
and 9.75 days for comparison group).
No significant difference noted in the
severity of pain between groups.
Rooney, S.M., Jain, 44 -thoracotomy for carcinoma TENS (n=22) vs sham-TENS -analgesic 22.7% of TENS group required no
S., Goldiner, P.L. of the lung (n=22) requirements narcotics for 24 hour period as
1983 -27 male and 17 female opposed to none in comparison group.
patients
-between ages of 20-70
years
McCallum, M.I., -decompressive lumbar TENS (n=10) vs sham-TENS -number of patient

Glynn, C.J., Moore, 39 laminectomy (n=10) demands for analgesia The use of TENS did not significantly
R.A., Lammer, P., -7 males and 13 females -total dose of alter the rate of demand analgesia.
Phillips, A.M. 1988 -mean age approximately morphine Plasma morphine requirements were
45 years -plasma morphine not significantly different between the
concentration two groups in the first 24 hrs.
Herman, E., 50 -work-related low-back TENS (n=29) vs sham-TENS -Roland-Morris TENS patients showed greater pain
Williams, R., injury of musculoskeletal (n=29) disability reduction immediately after application
Stratford, P., or fibromyalgic origin, 3- questionnaire of TENS than comparison group,
Fargas-Babjak, A., 10 weeks duration -present pain however, does not meet study's
Trott, M. 1994 -mean age TENS group perception on vertical definition for a clinically important
36.7 years, 24 male & 5 analogue scale change.
female, height 171.6 cm -return to work
-mean age comparison
group 41.7, 22 male & 7
female, mean height 172.5
cm, weight 128.6 kg
Ordog, G.J. 1987 47 -diagnoses consisted of 62 TENS (n=25) vs sham-TENS -10 point visual Statistically significant reduction in
sprains, 20 lacerations with (n=25) vs TENS and Tylenol analogue scale pain severity between TENS and
pain, 12 fractures, and 6 #3 (n=25) vs sham-TENS and placebo TENS day 2 but not at day 30.
hematomas and contusions Tylenol #3 (n=25)
-over 21 years old No significant difference between
TENS and TENS + Tyl #3 groups on
subjective levels of pain pre- and post-
treatment at day 2 and day 30.
Nordemar, R., 20.5 -acute cervical pain TENS (n=10) vs neck collar -cervical mobility TENS significantly increased total
Thöner, C. 1981 -in TENS group age 34"9, (n=10) vs manual treatment (total mobility range) mobility range more than neck collar.
and 3 males and 4 females (n=10) -pain severity on No significant differences between
-in neck collar group age visual analogue scale groups on pain index, although the
43"16, and 5 males and 5 manual treatment group had the highest
females value.
-in manual therapy group
age 42"17, and 4 males
and 6 females
Dawood, M.Y., 41 -severe primary Cross-over (n=32) Ibuprofen -self-rating of 25 Significantly less Ibuprofen was
Ramos, J. 1990 dysmenorrhea vs TENS vs sham-TENS menstrual symptoms required with TENS treatment than
-mean age 28.5 "5.2 years -quality of pain relief with either Ibuprofen alone or placebo
-menarche occurred at on 5 point scale TENS treatment at each of the 4-hour
11.9"1.4 years -analgesic intervals during first 12 hours and
-age of onset of requirements TENS significantly delayed the need
dysmenorrhea was for Ibuprofen.
"
18
CCOHTA
11.9"1.4 years for Ibuprofen.
TENS provided good to excellent pain
relief in 42.4% of subjects, sham-
TENS 3.2%.
Lundeberg, T., 31.5 -history of dysmenorrhea Cross-over (n=21) high- -McGill Pain Hf-TENS provided pain relief for 16
Bondesson, L., range from 18 mos. to 9 frequency TENS (n=7) vs Questionnaire out of 21 patients, 9 patients received
Lundström, V. 1985 years low-frequency TENS (n=7) -pain intensity on a pain relief from using lf-TENS, and 7
-mean age of patients 22 vs sham-TENS (n=7) visual analogue scale patients using the sham-TENS
years (15-29) -induction time for experienced pain relief.
-pain localized to lower pain relief
back -duration of pain relief
Lewers, D., 23.5 -females with primary TENS (n=10) vs placebo pill -pain severity on At the initial posttreatment
Clelland, J., dysmenorrhea (n=11) visual analogue scale measurement, the visual analogue scale
Jackson, F.R., -ranged in age from 20-38 (10cm) illustrated a 47.1% decrease in pain for
Varners, E.F., (mean 25.9) -Pain rating index the comparison group and 65.2%
Bergman, J. 1989 -mean age of menarche (PRI) decrease for the TENS group. The PRI
11.6 years in TENS and revealed a 55.6% pain reduction in the
12.1 years in comparison comparison group, and a 61.9%
group reduction in the TENS group. Not
significant.
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TENS and Acute Pain - Grade I Studies

Chalmers' et Characteristics Comparison Measures
al. (1981) Groups'
Score Characteristics
Smith, C.M., 36 -elective cesarean TENS (n=9) vs sham- -McGill pain Patients in the TENS group
Guralnick, M.S., delivery TENS (n=9) questionnaire reported significantly less
Gelfand, M.M., -multiparous -analgesic intake movement-associated cutaneous
Jeans, M.E. 1986 -mean age 30.5 for pain on postoperative days 1
TENS group and 28.0 and 2.
for comparison group No significant differences noted
in analgesic intake (TENS-
treated women received slightly
fewer doses).
Akyuz, G., 30 -various gynecological TENS (n=17) vs sham- -pain severity on TENS significantly decreased
Kayhan, O., procedures (eg. TENS (n=13) vertical pain scale pain on days 1, 2, and 3
Babacan, A., et abdominal -analgesic intake postoperative.
al. 1993 hysterectomy, -postoperative Six patients in TENS group and
oophorectomy, tubal paralytic ileus all patients in sham-TENS group
ligation, C-Section) required analgesic drugs.
-mean age 39.2 for Post-operative paralytic ileus
TENS group and 36 observed in 12% of TENS group
for comparison group and 54% in sham-TENS group.
Sim, D.T. 1991 25 -27 females and 3 TENS (n=15) vs -analgesic intake No significant differences in
males undergoing Papaveretum (n=15) -pain severity on opiate analgesic requirements
elective linear analogue (Day 1 mean for TENS group
cholecystectomy (right scale 49.0 mg and 46.67 mg for
upper paramedian -lung function comparison group and day 2
incision) parameters (FVC mean 12.0 mg for TENS group
-mean age 47.0 for and FEV1) and 18.0 mg for comparison
TENS group and 51.8 group).
for control group TENS group had significantly
lower rest pain and deep
breathing pain on day 2 post-op,
and cough pain on day 5 post-
op.
34
CCOHTA
al. (1981) Groups'
No significant difference in
forced expiratory volume (FEV1)
and forced vital capacity (FVC)
between groups (fall and rise of
values almost identical for both
groups).
Rosenberg, M., 20.5 -cholecystectomy TENS (n=6) vs Demerol -analgesic intake TENS group showed significant
Curtis, L., (midline upper prn (n=6) -incidence of ileus decrease in amount narcotics
Bourke, D.L. abdominal incision) -incidence of administered day 1 & 2 post-op.
1978 -mean age and weight atelectasis Presence of ileus similar in both
of TENS group 42 -respiratory groups.
years and 83.9 kg parameters (eg. One case of atelectasis in each
-mean age and weight FVC, FEV1) group.
of control group 43.2 Respiratory parameters nearly
years and 71.2 kg identical in each group.
Gilbert, J.M., 37.5 -unilateral inguinal TENS (n=20) vs sham- -pain severity on No significant difference
Gledhill, T., Law, herniorrhaphy for the TENS (n=20) visual analogue between groups for pain score,
N., et al. 1986 first time scale peak expiratory flow, and
-ages ranged from 24- -analgesic pethidine requirements.
77 requirements
-expiratory peak
flow
Smedley, F., 40 -unilateral inguinal TENS (n=34) vs sham- -pain severity on No significant differences in
Taube, M., herniorrhaphy for the TENS (n=28) linear analogue reported pain , peak expiratory
Wastell, C. 1988 first times scale flow rates, and analgesic
-ages ranged from 21- -analgesic intake requirements (0.9 doses per
83 -peak expiratory patient in TENS group and 0.85
flow doses per patient in comparison
group) between groups.
Cuschieri, R.J., 36 -elective abdominal TENS (n=53) vs sham- -pain severity on No significant differences
Morran, C.G., surgery TENS (n=53) linear analogue between groups in reported pain
McArdle, C.S. scale (similar scores), morphine
al. (1981) Groups'
McArdle, C.S. -39 male and 62 female scale (similar scores), morphine
1985 patients -analgesic requirements (mean 59 mg of
-ages ranged from 14- requirements morphine in TENS group and 50
81 years -arterial blood gas mg in comparison group), and
values arterial blood gas analysis (on
postoperative day 1 mean PaO 2
for TENS group 9.2 kPa and 9.7
kPa for comparison group, etc.).
Cooperman, A., 34.5 -major intra-abdominal TENS (n=27) vs sham- -analgesic intake 77% of patients with active TENS
Hall, B., surgery with upper TENS (n=23) received excellent (required no
Mikalacki, K., abdominal midline medicine or occasional dose of
Hardy, R., Sadar, incisions diazepam) or good results
E. 1977 -26 female and 24 male (required diazepam and less
patients than 3 doses of Demerol every
-ages ranging from 20 24 hours) as compared to 33% of
to 74 years patients with sham TENS.
Conn, I.G., 40 -consecutive patients TENS (n=15) vs sham- -pain severity on No significant difference of
Marshall, A.H., undergoing emergency TENS (n=13) vs linear analogue reported pain in TENS and
Yadav, S.N., appendectomy papaveretum/mefenamic scale sham-TENS groups, however
Daly, J.C., Jaffer, -18 male patients, 24 acid (n=14) -analgesic intake pain severity significantly
M., 1986 female patients greater in
-age range of patients papaveretum/mefenamic acid
13-58 years group.
Papaveretum/mefenamic acid
group required significantly
more analgesia than other two
groups in first and second 24
hours.
Patients in TENS group asked
for significantly less analgesia in
first 24 hours than the sham-
TENS group.
VanderArk, G.D., 33 -receiving abdominal TENS (n=61) vs sham- -pain severity on 77% of TENS group and 17% of
McGrath, K.A. or thoracic procedures TENS (n=39) scale of 1 to 10 sham-TENS group experienced
36
CCOHTA
al. (1981) Groups'
McGrath, K.A. or thoracic procedures TENS (n=39) scale of 1 to 10 sham-TENS group experienced
1975 (thoracic, inguinal -duration of pain some form of pain relief.
hernia repair, relief Postoperative ileus was
cholecystectomy, -analgesic apparent in 18% of comparison
appendectomy, hernia requirements group and 16% in TENS group.
repair, vagotomy and -presence of Atelectasis present in 5% of
antrectomy) atelectasis each group.
-range of ages 13-87 -presence of ileus
Stubbing, J.F., 23.5 -thoracotomies TENS (n=20) vs -analgesic Mean dose of papaveretum in
Jellicoe, J.A. -in TENS group mean papaveretum (n=20) requirements first 24 hours not significant
1988 age 54 m:f ratio 13:7, -peak expiratory (53.5 mg in TENS group and 52.5
and flow rate mg in comparison group).
mean weight 61.3 kg -requirements for Postoperative peak expiratory
-in the group receiving antiemetic drugs flow rates comparable between
papaveretum mean -length of hospital groups.
age 53, m:f ratio 15:5, stay Five patients in TENS group
mean weight 69.2 kg -pain severity on 0 required antiemetics and 11 in
to 4 scale the comparison group.
Mean length of stay in hospital
not significant (10.25 days for
TENS group and 9.75 days for
comparison group).
No significant difference noted
in the severity of pain between
groups.
Rooney, S.M., 44 -thoracotomy for TENS (n=22) vs sham- -analgesic 22.7% of TENS group required
Jain, S., carcinoma of the lung TENS (n=22) requirements no narcotics for 24 hour period
Goldiner, P.L. -27 male and 17 female as opposed to none in
1983 patients comparison group.
-between ages of 20-70
years
McCallum, M.I., 39 -decompressive TENS (n=10) vs sham- -number of patient The use of TENS did not
Glynn, C.J., lumbar laminectomy TENS (n=10) demands for significantly alter the rate of
Moore, R.A., -7 males and 13 analgesia demand analgesia.
al. (1981) Groups'
Lammer, P., females -total dose of Plasma morphine requirements
Phillips, A.M. -mean age morphine were not significantly different
1988 approximately 45 years -plasma morphine between the two groups in the
concentration first 24 hrs.
Herman, E., 50 -work-related low-back TENS (n=29) vs sham- -Roland-Morris TENS patients showed greater
Williams, R., injury of TENS (n=29) disability pain reduction immediately after
Stratford, P., musculoskeletal or questionnaire application of TENS than
Fargas-Babjak, fibromyalgic origin, 3- -present pain comparison group, however,
A., Trott, M. 1994 10 weeks duration perception on does not meet study's definition
-mean age TENS group vertical analogue for a clinically important change.
36.7 years, 24 male & 5 scale
female, height 171.6 -return to work
cm
-mean age comparison
group 41.7, 22 male &
7 female, mean height
172.5 cm, weight 128.6
kg
Ordog, G.J. 1987 47 -diagnoses consisted TENS (n=25) vs sham- -10 point visual Statistically significant reduction
of 62 sprains, 20 TENS (n=25) vs TENS analogue scale in pain severity between TENS
lacerations with pain, and Tylenol #3 (n=25) vs and placebo TENS day 2 but not
12 fractures, and 6 sham-TENS and Tylenol at day 30.
hematomas and #3 (n=25)
contusions No significant difference
-over 21 years old between TENS and TENS + Tyl
#3 groups on subjective levels of
pain pre- and post-treatment at
day 2 and day 30.
Nordemar, R., 20.5 -acute cervical pain TENS (n=10) vs neck -cervical mobility TENS significantly increased
Thöner, C. 1981 -in TENS group age collar (n=10) vs manual (total mobility total mobility range more than
34"9, and 3 males and treatment (n=10) range) neck collar.
4 females -pain severity on No significant differences
-in neck collar group visual analogue between groups on pain index,
age 43"16, and 5 scale although the manual treatment
males and 5 females group had the highest value.
38
CCOHTA
al. (1981) Groups'
males and 5 females group had the highest value.
-in manual therapy
group age 42"17, and
4 males and 6 females
Dawood, M.Y., 41 -severe primary Cross-over (n=32) -self-rating of 25 Significantly less Ibuprofen was
Ramos, J. 1990 dysmenorrhea Ibuprofen vs TENS vs menstrual required with TENS treatment
-mean age 28.5 "5.2 sham-TENS symptoms than with either Ibuprofen alone
years -quality of pain or placebo TENS treatment at
-menarche occurred at relief on 5 point each of the 4-hour intervals
11.9"1.4 years scale during first 12 hours and TENS
-age of onset of -analgesic significantly delayed the need
dysmenorrhea was requirements for Ibuprofen.
11.9"1.4 years TENS provided good to excellent
pain relief in 42.4% of subjects,
sham- TENS 3.2%.
Lundeberg, T., 31.5 -history of Cross-over (n=21) high- -McGill Pain Hf-TENS provided pain relief for
Bondesson, L., dysmenorrhea range frequency TENS (n=7) Questionnaire 16 out of 21 patients, 9 patients
Lundström, V. from 18 mos. to 9 vs low-frequency TENS -pain intensity on a received pain relief from using lf-
1985 years (n=7) vs sham-TENS visual analogue TENS, and 7 patients using the
-mean age of patients (n=7) scale sham-TENS experienced pain
22 years (15-29) -induction time for relief.
-pain localized to lower pain relief
back -duration of pain
relief
Lewers, D., 23.5 -females with primary TENS (n=10) vs placebo -pain severity on At the initial posttreatment
Clelland, J., dysmenorrhea pill (n=11) visual analogue measurement, the visual
Jackson, F.R., -ranged in age from scale (10cm) analogue scale illustrated a
Varners, E.F., 20-38 (mean 25.9) -Pain rating index 47.1% decrease in pain for the
Bergman, J. -mean age of (PRI) comparison group and 65.2%
1989 menarche 11.6 years in decrease for the TENS group.
TENS and 12.1 years The PRI revealed a 55.6% pain
in comparison group reduction in the comparison
group, and a 61.9% reduction in
al. (1981) Groups'
the TENS group. Not significant.
40
CCOHTA
TENS and Acute Pain - Grade II Studies
Trial Participants' Intervention/ Comparison Outcome Results

Characteristics Groups' Characteristics Measures
Hollinger, J.L. -giving birth by cesarean TENS (n=46) vs regular pain -hospital stay in Length of stay was not statistically
1986 section control such as Demerol, hours significant.
-17 - 45 years of age Acetaminophen/codeine (n=26) -analgesic Total intake of Demerol significantly
requirements higher in non-TENS users.
Total intake of acetaminophen/codeine
not significantly different between
groups.
Bussey, J.G., -134 males (75 TENS (n=86) vs pain medication -analgesic In patients having herniorrhaphy ,
Jackson, A. 1981 herniorrhaphies and 59 (n=122) requirements statistically significant reductions in
cholecystectomies) pain medication in TENS group (65%)
-76 females and by day 3 postoperative required no
(cholecystectomies) pain medication.
-age ranged from 15-75
years
Torres, W.E. et al. -candidates for biliary TENS (n=79) vs I.V. -IV amount of The mean dose of fentanyl citrate was
1992 lithotripsy sedation/medication (n=44) fentanyl citrate significantly reduced by33.6% and the
-53 females and 26 males and/or midazolam mean dose of Midazolam HCl was
-mean age 30 years, HCL required significantly reduced by 22.9% in the
range 23-99 years TENS group.
The mean dosage in women receiving
TENS was significantly reduced by
45.4% and the mean dose in men
receiving midazolam HCl was
significantly reduced by 38.9%.
Issenman, J., -spinal fixation with TENS (n=10) vs sham-TENS -analgesic Comparison group took more doses of
Nolan, M.F., Harrington rods (n=10) requirements morphine sulfate, diazepam, and
Rowley, J., -17 females, 3 males propoxyphene napsylate , and
Hobby, R. 1985 -ranged in ages from 13- meperidine chloride than TENS group.
25 years Acetaminophen with codeine,
hydroxyzine hydrochloride
administered more often to TENS
patients.
Hansson, P., -presented to emergency TENS (n=9) vs low frequency -visual analogue None of the patients received sufficient
Ekblom, A. 1984 clinic for dental and oral TENS (n=9) vs vibratory scale analgesia to continue through operative
surgery with pain caused stimulation (n=9) vs sham-TENS -ability to complete treatment without conventional
by pericoronitis, pulpitis, (n=5) vs sham-vibratory surgical treatment medicine.
or abscess formation stimulation (n=5)
-16 males and 21 females
-patients ranged in age
from 20-62 years
42 CCOHTA
TENS and Chronic Pain - Grade I Studies

al. (1981) Groups'
Deyo, R.A., 57 -low back pain for at TENS (n=36) vs sham- -11 indicators of No significant treatment effect of
Walsh, N.E., least 3 months. TENS (n=36) vs TENS pain, function, and TENS for outcomes (functional
Martin, D.C., -93% given nonspecific and exercise (n=37) vs back flexion status, pain ratings, physician
Schoenfeld, L.S., diagnoses (eg. chronic sham-TENS and exercise measures, use of medical
Ramamurthy, S. lumbar strain, (n=36) services) together, or for any
1990 myofascial pain), 3% n=145 to start, n=125 for individual outcome.
had pain due to calculations Overall improvement was 47% in
degenerative disk TENS group and 42% in group
disease, remainder with sham-TENS.
were a variety
-ages ranged from 18
to 70 years
Melzack, R., 42.5 -19 men and 22 women TENS (n=20) vs -pain relief TENS produced significantly
Vetere, P., Finch, for treatment of low mechanical massage assessed by two larger changes on the Pain
L. 1983 back pain (n=21) measures of Rating Index and Present Pain
-average age 46.3 McGill Pain Intensity scale.
years Questionnaire TENS produced significantly
-average duration of -straight leg larger changes in straight leg
pain was 36.2 weeks raising raising than massage in left and
-back flexion right legs.
No significant difference
between groups in back flexion.
Melzack, R., 25 -history of chronic Cross-over TENS (n=22) -pain relief Cross-over decrease for ice
Jeans, M.E., low-back pain for a vs ice massage (n=22) assessed by massage significant on Present
Stratford, J.G., mean duration of 7.4 McGill Pain Pain Intensity scale.
Monks, R.C. years Questionnaire Of 29 patients allowed to choose
1980 -23 men and 21 women preferred treatment, 13 chose
-aged 18-73 years TENS, 9 chose ice, and 5 found
neither effective.
Lehman, T.R., et 44 -chronic disabling low TENS (n=18) vs sham- -pain severity No significant differences
al. 1986 back pain for more TENS (n=18) vs assessed on visual between groups of the overall
al. (1981) Groups'
al. 1986 back pain for more TENS (n=18) vs assessed on visual between groups of the overall
than 3 months. electroacupuncture analogue scale rehabilitation although
-17 female subjects (n=17) -patient and electroacupuncture group
-ages range from 25 to physician consistently achieved greater
55 years, mean 40 assessment of improvement on all outcome
-all had low back pain disability measures (including measure of
for more than 6 -trunk strength pain).
months. -spine range of All 3 treatment groups ranked
-diagnoses included motion education as having the greatest
unknown, lumbar -patients' contribution over electrical
motion segment perception of stimulation.
instability, lumbar treatments
spinal stenosis,
herniated disc, etc.
Mannheimer, C., Long-term study -angina pectoris TENS (n=11) vs no TENS -mean exercise In TENS group, mean exercise
Carlsson, C. -A., 22 -pts. between 41 and (n=10) tolerance tolerance higher in treatment
Vedin, A., 71 years -various cardiac period than run-in and mean ST
Wilhelmsson, C. parameters (eg. ST depression also decreased in
1986 segment treatment period.
depression, At highest comparable work
systolic blood load, no significant differences
pressure, heart in heart rate and systolic blood
rate) pressure.
-number of anginal
attacks
-nitroglycerin
consumption
Fargas-Babjak, 44 -suffered from TENS (n=19) vs sham- -pain level As measured by visual analogue
A., Rooney, P., osteoarthritis of the TENS (n=18) measured on scale, improvement in pain level
Gerecz, E. 1989 hip and knee for more visual analogue of 74% of TENS group and 27.8%
than 7 months. scale, West Haven in sham-TENS group.
Yale
Multidimensional
Pain Inventory,
and Percent
Improvement Pain
44 CCOHTA
al. (1981) Groups'
Scale
Geirsson, G., 30.5 -women with chronic Cross-over, n=12 -voiding frequency No significant difference in
Wang, Y. -H., interstitial cystitis Acupuncture vs TENS -mean voided voiding frequency, mean voided
Lindström, S., -ages 22 to 80 years volume volume, maximal voided volume
Fall, M. 1993 (median 41) -maximum voided or visual symptom scores before
volume or after either treatment (mean
-symptom score scores almost identical for both
on a scale of 0 to treatments).
10
Langley, G.B., 41 -classic or definitive TENS (n=11) vs -pain at rest and All groups achieved a similar
Sheppeard, H., rheumatoid arthritis "acupuncture-like" pain while gripping overall relief (TENS- 54.5%,
Johnson, M., -chronic hand stimulation (n=11) vs assessed on 10 cm "acupuncture-like" - 40.9%, and
Wigley, R.D. involvement sham-TENS (n=11) visual analogue sham-TENS - 54.5%).
1984 -in TENS group mean scale
age 54.9 years, mean -joint tenderness
duration of disease -grip strength
11.3 years
-in acupuncture-like
group mean age 53.7
years, duration 11.7
years
-in sham-TENS group
mean age 53.4 years,
duration 10.7 years
Griffin, J.W., 34.5 -chronic posttraumatic High Voltage Pulsed -hand volume Hand volume measurements
Newsome, L.S., hand edema (edema Current (HVPC) (n=10) measurements to significantly different between
Stralka, S.W., persisting for 14 - 21 vs placebo-HVPC (n=10) assess hand IPC and placebo-HPVC but no
Wright, P.E. 1990 days following injury) vs Intermittent edema significant difference between
-ages ranged from 21- Pneumatic Compression HVPC and IPC.
84 years (IPC) (n=10) Difference between HVPC and
-amount of time of placebo-HVPC did not reach
postinjury ranged from statistical significance.
3 to 20 weeks
Thorsteinsson, 42.5 -chronic pain for at Cross-over, n=93 (for -duration of relief Sham-TENS had an overall
G., Stonnington, least 1 month calculations) TENS vs effective response rate of 32%
al. (1981) Groups'
G., Stonnington, least 1 month calculations) TENS vs -patient response effective response rate of 32%
H.H., Stilwell, -majority with sham-TENS and actual TENS had an overall
G.K., Elveback, neuropathies and low effective response of 48%.
L.R. 1978 back pain Difference in the duration of the
-53 women and 40 men effect between groups was not
finished trial significant.
-mean age 48.7 years
-63 patients had single
centre of pain, 30
patients had multiple
centres of pain
-82 patients reported
constant pain, 11 with
intermittent pain
46 CCOHTA
TENS and Chronic Pain - Grade II Studies

Mannheimer, C., -all patients. suffering Short-Term Study Short Term Study Short Term Study
Carlsson, C. -A., from angina pectoris TENS vs no TENS (n=10) -pulse rate, blood During TENS treatment, patients
Vedin, A., pressure, showed increased maximal work
Wilhelmsson, C. Short-term Study -maximal total work capacity, decrease in magnitude of ST
1986 -all male patients -estimation of pain, segment depression during maximal
between 40 and 65 years dyspnea, fatigue work and immediately after exercise.
-ST changes At maximum work level, heart rate,
-recovery time blood pressure/heart rate product did
not significantly differ with or without
TENS (means were almost identical).
Mannheimer, C., -all patients suffering Invasive Study -various systemic Invasive Study
Carlsson, C. -A., from angina pectoris TENS vs no TENS (n=13) and coronary During pacing to same heart rate,
Vedin, A., hemodynamic and systolic blood pressure significantly
Wilhelmsson, C. Invasive Study myocardial lower with TENS treatment.
1986 -2 females and 11 males metabolic measures At same heart rate producing angina in
-between the ages of 45 were used control situation, 10 patients were free
and 64 (mean 55 years) from pain after TENS and could be
paced to higher frequency.
Ballegard, S., -patients with chronic Cross-over, n=13 -characteristics of No significant differences noted in pain-
Christophersen, pancreatitis Electroacupuncture vs sham- pain assessed on rating variables (VAS, intake of
S.J., Dawids, -no alcohol abuse or electroacupuncture visual analogue analgesics, VAS of well-being,
S.G., Hesse, J., other cause of Cross-over, n=16 TENS vs sham- scale preference) between TENS and sham-
Olsen, N.V. 1985 abdominal pain TENS -analgesic TENS groups.
-11 men, 6 women requirements
completed trial
-median age 45 years
(range 29-64)
-median years diagnosed
with pancreatitis 9 year
(range 1-19 years)
Tulgar, M., -21 diagnoses (multiple Cross-over, n=14 Conventional -pain assessed on 4 of 8 patients with lower back pain
McGlone, F., in 7 patients), low-back mode TENS vs Burst stimulation visual analogue responded to HRFM
Bowsher, D., pain, sciatica, brachial vs High-rate frequency-modulated scale 3 of 4 patients with sciatica responded
Miles, J.B. 1991 plexus syndrome, post- stimulation (HRFM) vs Low-rate -duration of pain to burst stimulation
herpetic neuralgia, frequency-modulated stimulation relief After 3 months, 7 of 8 patients continue
central post-stroke pain, (LRFM) to use portable stimulators, and are not
post-thoracotomy scar taking the previously required analgesic
pain, phantom limb pain, medication.
chronic tension
headache
-7 male and 7 female
patients
-range in ages from 36-
76 (mean 54 years)
Long, D.M., -175 females and 125 First Series -patient satisfaction First Series
Campbell, J.N., males TENS vs subliminal TENS vs During first 24 hours, 90% described
Gucer, G. 1979 First Series sham-TENS (n=150) some beneficial effect, however, this
-patients. with chronic dropped to 60% at end of second day.
pain of various origins Second Series 35% were achieving pain relief after 1
admitted to hospital for TENS only (n=150) month.
evaluation 11% using batteryless unit thought it
-diagnoses similar to was successful in pain relief and 8%
second series using subliminal stimulation found it
was successful in pain relief.
Second Series
-collected over 3 yr. Second Series
period TENS was helpful in a significant
-general diagnoses number of patients with peripheral
include lumbar pain, nerve injuries, postherpetic neuralgia,
cervical pain, peripheral and chronic lumbar and cervical
nerve injury, disorders.
postherpetic neuralgia, A good initial significant response in
metabolic peripheral exaggerated response patients but it
neuropathy, was not maintained
psychogenic pain
disorder, exaggerated
pain disorder
48 CCOHTA
TENS and Chronic Pain - Grade III Studies

Fried, T., -chronic pain from Review of Workers' -subjective Success of TENS increased from 18.6%
Johnson, R., industrial trauma Compensation Board files assessment of pain in 1975 to 20.4% in 1976, 28.2% in 1977,
McCracken, W. -many patients had other (n=846), patients who received -sleeping patterns 35.2% in 1978, and 39.6% in 1979.
1984 physical and TENS -analgesic
psychological problems requirements Questionnaire
Questionnaire, n=637, response Benefit of TENS reported by 83.8% with
rate 88.4% 418 noting less pain.
-all patients receiving TENS since
1978
Don, R.G., Tay, -various neurological/ TENS only (n=20) -subjective pain 50% of patients reported good results
G. 1982 orthopedic disorders assessment from TENS (reduction in pain
cause of chronic pain -mobility variables), 25% of patients reported fair
-15 males, 5 females -analgesic results (some reduction in pain
-ages range from 16-66 requirements variables), and 25% reported poor
results (minimal or poor reduction in
pain variables).
Procacci, P., Clinical Applications TENS only (n=168) -electromyography 1) good results, similar to local
Zoppi, M., -patients with following -Hoffman reflex anesthetics
Maresca, M., chronic pain syndromes: 2) disappearance of pain if <3 months.
Francini, F. 1977 Various pain conditions 3) best results if not previously treated
1) fibrositis (n=71) 4) poor results
2) post-herpetic 5) only 3 had relief for long time
neuralgia (n=16) 6) poor results, pain relief lasted for
3) trigeminal neuralgia only a few minutes after stimulation
etc. (n=25 7) 6 patients received lengthy pain
4) causalgia (reflex relief
sympathetic dystrophies 8) reduction of pain for 1-2 hours
(n=12)
5) painful scars (n=12)
6) post-traumatic fibre
dissociation (n=7)
7) phantom limb pain
(n=7)
8) cancer pain (n=18)
Loeser, J.D., -various etiologies of TENS only (n=198) -subjective pain 31.8% patients received no significant
Black, R.G., chronic pain (eg. low relief pain relief after 3 trials of TENS.
Christman, A. back pain, cervical -long-term pain 68% experienced initial relief of
1975 arthritis, causalgia, relief symptoms after 3 trials of TENS.
headache) 12.1% maintained effective pain relief
-age range 16-83 years with TENS on a long-term basis
-92 male and 106 female (followed for at least 1 year).
patients
50 CCOHTA
TENS and Labour Pain - Grade I Studies

al. (1981) Groups'
Erkkola, R., 30.5 -mean age in TENS group TENS (n=100) vs -subjective reporting When cervix dilated less than 7 cm,
Pikkola, P., 25.8 years, in comparison conventional pain of pain significantly more mothers in TENS
Kanto, J. 1980 group 26.1 medications (n=100) group reported a painful labour.
-mean duration of labour No significant difference in subjective
403 min. in TENS and 408 reporting of pain after 7 cm dilation.
in control
Neshiem, B. -I. 38.5 -median age was 26-27 TENS (n=35) vs sham-TENS -pain severity on 5 No significant difference in the
1981 years (n=35) point scale reported degree of pain relief obtained
-normal birth and child -analgesic in between groups (shortly after
expected requirements labour).
-26 primigravidas and 24 Comparison group received more
multigravidas regional blocks than TENS group. The
same number of patients received
pethidine and diazepam.
Harrison, R.F., 39.5 -100 primigravidas and 50 TENS (n=76) vs sham-TENS -patient pain No significant differences in the
Woods, T., Shore, multigravidas (n=64) assessment on a scale patients' or midwives' assessment of
M., Matthews, G., of 0 to 4 pain relief.
Unwin, A. 1986 -midwife pain 12% and 48% of primigravida and
assessment on scale of para 2 women respectively receiving
0 to 4 TENS did not require further pain
-analgesic medication and 13% and 39% of those
requirements in the comparison group.
Significantly more TENS users would
request TENS again.
Bundsen, P., 28 -mean age of mother in TENS (n=15) vs conventional -pain assessment on a When less than 5 cm dilated, 3 women
Ericson, K., TENS group 28 years, pain medication (n=9) such as 5-point scale in the TENS group and 5 women with
Peterson, L. -E., mean age in control group nitrous oxide-oxygen conventional pain medications had
Thiringer, K. 1982 26 years mixture, pethidine, diazepam, severe to unbearable low back pain
-8 primigravidas, 16 extradural analgesia (EDA), and 10 women in the TENS group and
multigravidas paracervical block (PCB) and 7 in the control group had severe
-all were induced labours pudendal block suprapubic pain.
When dilated more than 5 cm, 1 woman
in the TENS group and 10 women in
the control group had severe low back
pain, and 7 women in the TENS group
and 5 women in the control group had
severe suprapubic pain.
Hughes, S.C., 17.5 -in active labour, vertex TENS (n=29) vs sham-TENS -pain severity on No significant difference between
Dailey, P.A., presentation, cervical (n=30) vs conventional pain visual analogue scale groups in the percentage of patients
Partridge, c. 1988 dilation of #5 cm medications (n=30) -pain relief on 5-point receiving narcotics or epidurals
-comparable in age, height, scale by patient and (epidurals: 21% in TENS group, 33%
weight, weeks of gestation, nurse in sham-TENS group, 27% in control
cervical dilation, and -analgesic group; narcotics: 28%, 33%, 40%
incidence of oxytocin requirements respectively).
augmentation of labour 93% of patients using TENS vs 62%
using sham-TENS had good to
excellent pain relief.
93% or TENS group and 59% of
sham-TENS group would use TENS
again.
Thomas, I.L., Tyle, 54 -primigravidas and TENS (n=132) vs sham- -pain severity on a No significant difference for low back
V., Webster, J., multigravidas in early TENS (n=148) visual analogue scale pain or abdominal pain mean scores
Neilson, A. 1988 labour -questionnaire the day between both groups for any of the
-comparable in age, length after delivery three stages of labour
of gestation No significant difference for the
requirement amounts of nitrous oxide
and pethidine used.
Significantly more women in TENS
group said would use TENS in another
labour.
Harrison, R.F., 10.5 -all primigravidas Epidural (n=50) vs Entonox -pain severity on a 0 Epidural was most effective providing
Shore, M., Woods, (n=20) vs TENS (n=50) vs to 4 scale complete relief in 88%, partial relief in
T.,Matthews, G., Pethidine and promazine -after delivery, 90% of Entonox, 96% of TENS, and
Gardiner, J., Unwin, (n=50) questionnaire for 54% of pethidine and promazine
A. 1987 comments groups had partial relief.
52 CCOHTA
Chia, Y.T., 29 Part I Part I -pain severity on scale Part I
Arulkumaran, S., -mean age 28.4"4.2 years TENS (n=48) vs Entonox of 0 to 10 91.7% of TENS and 96.2% of Entonox
Chua, S., Ratnam, in TENS group, 28.3"4.3 (n=53) -analgesic experienced pain between 6-10 (on a
S.S. 1990 years in Entonox group requirements scale of 1-10), differences not
-number primigravidas 26 Part II statistically significant.
in TENS group 33 in TENS (n=10) vs Entonox
Entonox group (n=10) Part II
Cross-over TENS provided partial relief in 89%
Part II and Entonox provided partial relief in
-primigravidas to have 50% (not significant).
surgical induction Using Entonox after TENS, 66.6%
found partial relief, 44.4% using TENS
after Entonox found partial relief (not
significant).
TENS and Labour Pain - Grade III Studies

Grim, L.C., -11 primigravidas and 4 TENS (n=15) vs few contractions -degree of pain at 13 of 15 women gave TENS an
Morey, S.H. 1985 multigravidas without TENS various stages of moderate to excellent rating.
-ages between 21 and 34 labour determined
years old through the use of 13 women expressed a desire to use
a questionnaire TENS future labours.
Gowers, S.R. -multigravida TENS only (n=1) -analgesic Patient very satisfied with TENS,
1985 requirements requiring no further pain medication
-patient's
verbalizations
Keenan, D.L., -29 year old woman TENS (n=1) vs few contractions -patient's subjective Patient more comfortable with TENS
Simonsen, L., -first pregnancy, without TENS comfort than without it.
McCrann, D.J. gestation 42 weeks
1985
54 CCOHTA

Transcutaneous Electrical Nerve Stimulation (Tens) and Pain Management

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Transcutaneous Electrical Nerve Stimulation (Tens) and Pain Management

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Canadian Coordinating Office for Health Technology Assessment

Office Canadien de Coordination de l'Évaluation des Technologies de la Santé

TRANSCUTANEOUS ELECTRICAL NERVE

110-955 Green Valley Crescent

Vous pouvez aussi vous procurer la

Reproduction of this document for non-commercial

Legal Deposit - 1995

Dr. J. D. Cassidy Assistant Professor of Orthopaedics

Dr. H. Hall Consulting Orthopaedic Surgeon

VI. DISCUSSION/CONCLUSIONS .............. 11

Table 1 Sample Size ..................................................................... 6

Table 2 Reimbursement Schemes ........................................... 11

Table 3 Summary of the Results of the Survey

A literature search was conducted on the following databases:

1. MEDLINE: from 1985 to March 1994;

$ "transcutaneous electric nerve stimulation" in the title or as a descriptor;

I: Randomized controlled trials;

Summary tables describing participants' characteristics, intervention/ comparison groups'

Information on prices of TENS units was obtained from the manufacturers.

In order to determine the status of TENS as a reimbursable procedure in Canada, a questionnaire

Survey of Canadian Hospitals

Labour Pain (12 studies reviewed; Grade I: 8, Grade III: 4)

No economic evaluation of TENS exists in the published literature. Therefore, no conclusions on

In four jurisdictions (New Brunswick, Quebec, Ontario and Saskatchewan), physician-provided

Payment to Other Categories of Health Professionals

Province Description of TENS-related reimbursable services Number of services and total

New Brunswick - Initial visit, including consultation, examination, 1 service

Quebec - Evaluation of the effectiveness of TENS in Claimed 212 times to a total

- Electrotherapies which could include TENS (may Claimed 64,600 times to a

Ontario There is a general code for therapeutic procedures Not available

Survey of Canadian Hospitals

TENS, when used in hospital, is provided largely by physiotherapists (97.7%). Physicians

Table 3 Summary of Results of the Survey of Canadian Hospitals

Application Percentage of Approximate usage in

Chronic pain 95.5% 2 times/year to 62 times/day

Acute pain 93.2 6 times/year to 29 times/day

Labour pain 43.0 1 time/year to 1 time/3weeks

Acute, chronic, 36.0 --

The Placebo Effect

Trial Modified Participants' Intervention/ Outcome Results

McCallum, M.I., -decompressive lumbar TENS (n=10) vs sham-TENS -number of patient

Gowers, S. R. 1985. A stimulating experience. Midwives Chronicle. 98 (1174) : 295-296.

Trial Modified Participants' Intervention/ Outcome Results

Trial Participants' Intervention/ Comparison Outcome Results

Trial Modified Participants' Intervention/ Outcome Results

Trial Participants' Intervention/ Comparison Outcome Results

Trial Participants' Intervention/ Comparison Outcome Results

Trial Modified Participants' Intervention/ Outcome Results

Trial Participants' Intervention/ Comparison Outcome Results

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