Primary studies included in this systematic review

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A pilot study on using acupuncture and transcutaneous electrical nerve stimulation to treat chronic non-specific low back pain

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Authors Itoh K , Itoh S , Katsumi Y , Kitakoji H
Journal Complementary therapies in clinical practice
Year 2009
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Objective: The present study tests whether a combined treatment of acupuncture and transcutaneous electrical nerve stimulation (TENS) is more effective than acupuncture or TENS alone for treating chronic low back pain (LBP). Methods: Thirty-two patients with chronic LBP were randomly allocated to four groups. The acupuncture group (ACP) received only acupuncture treatment at selected acupoints for low back pain; the TENS group (TENS) received only TENS treatment at pain areas; the acupuncture and TENS group (A&T) received both acupuncture and TENS treatments; the control group (CT) received topical poultice (only when necessary). Each group received specific weekly treatment five times during the study. Outcome measures were pain intensity in terms of visual analogue scale (VAS) and QOL of low back in terms of Roland-Morris Disability Questionnaire (RDQ). Results: The ACP, TENS and A&T groups all reported lower VAS and RDQ scores. Significant reduction in pain intensity (P < 0.008) and significant improvement in QOL (P < 0.008) were shown in the A&T group. Conclusion: Combined acupuncture and TENS treatment is effective in pain relief and QOL of low back improvement for the sampled patients suffering from chronic LBP. © 2008 Elsevier Ltd. All rights reserved.

Primary study

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Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain.

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Journal Clinical rehabilitation
Year 2008
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: To examine the effectiveness of rhythmic stabilization exercises and transcutaneous electrical nerve stimulation (TENS) and their combination in treating women with chronic low back pain. DESIGN: Sequentially allocated, single-blinded and controlled study, with a two-month follow-up. SETTING: The data were collected in a patient rehabilitation setting. SUBJECTS: A total of 92 women (34-46 years old) with chronic low back pain were studied. INTERVENTIONS: Sequential allocation was undertaken into four groups: ;rhythmic stabilization' (n=23), ;rhythmic stabilization - TENS' (n=23), TENS (n=23), and a placebo group (n = 23). Each programme lasted for four weeks. All outcome measures were assessed prior to, immediately after, four weeks and eight weeks post intervention. MAIN MEASURES: Data were obtained on functional disability, pain intensity, trunk extension range of motion, dynamic endurance of trunk flexion and static endurance of trunk extension. RESULTS: A total of 88 patients provided two-month follow-up data. The ;rhythmic stabilization' and the ;rhythmic stabilization - TENS' groups displayed statistically significant (P<0.05) improvements in functional disability and pain intensity (ranging from 21.2 to 42.8%), trunk extension range of motion (ranging from 6.5 to 25.5%), dynamic endurance of trunk flexion and static endurance of trunk extension (ranging from 13.5 to 74.3%) compared with the remaining groups. CONCLUSIONS: The rhythmic stabilization programmes resulted in more gains in women with chronic low back pain regarding the present outcome variables compared with the other groups; therefore, its application in female chronic low back pain patients aged 34-46 years is recommended.

Primary study

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A double blind randomised controlled clinical trial on the effect of transcutaneous spinal electroanalgesia (TSE) on low back pain.

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Authors Thompson JW , Bower S , Tyrer SP
Journal European journal of pain (London, England)
Year 2008
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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A double blind randomised controlled clinical trial on the effect of transcutaneous spinal electroanalgesia (TSE) on low back pain was carried out in 58 patients attending a Pain Management Unit. Four TSE instruments, two active and two sham, were used and each patient was assigned randomly to one of these. Low back pain was rated by each patient using a visual analogue scale (VAS) immediately before and immediately after a single 20 min treatment of TSE and also daily for the week prior to, and the week following, the treatment. No significant difference in mean pain score was detected between the active and sham treated groups immediately after treatment or during the subsequent week. The Hospital, Anxiety and Depression scale (HAD) and the General Health Questionnaire (GHQ) were completed by each patient and there was a positive correlation between the scores achieved on these scales and the mean pain scores in both the active and sham treated groups. A post-trial problem was the discovery that the specification of the two active TSE machines differed from the manufacturer's specification. Thus, the output frequencies were either more (+10%) or less (-17%) while the maximum output voltages were both less (-40% and -20%), respectively. However, additional statistical analysis revealed no significant differences between the results obtained with the two active machines. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Primary study

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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

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Journal Neuromodulation : journal of the International Neuromodulation Society
Year 2007
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This article is included in 1 Broad synthesis Broad syntheses (1 reference) 1 Systematic review Systematic reviews (1 reference)

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Objectives. Newly developed bidirectional modulated sine waves (BMW) might provide some derived benefit to patients with low back pain. Pain relief by transcutaneous electric nerve stimulation (TENS) with BMWs was tested. Materials and Methods. Analgesic effects of BMWs and conventional bidirectional pulsed waves on chronic back pain in 28 patients were compared, and effects of repeated TENS using BMWs on chronic back pain were investigated in 21 patients by means of a randomized double-blind, sham-controlled, parallel-group method. Pain intensity was assessed using numerical rating scale (NRS). Results. There was significant immediate reduction in NRS in patients receiving BMWs, and 60 min after treatment compared to sham TENS. Weekly repeated treatments using massage and TENS with BMWs for 5 weeks resulted in a decrease of NRS, but there were no significant differences between the TENS plus massage and sham TENS plus massage groups. Conclusions. This study shows that TENS with BMWs significantly inhibits chronic back pain, and treatment effects are attained within a day. The results also suggest that there were no statistically significant long-term effects of TENS with BMW in the repeated treatment. © 2007 International Neuromodulation Society.

Primary study

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Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Low-back Pain in a Multiple Sclerosis Population: A Randomized, Placebo-controlled Clinical Trial.

Journal The Clinical journal of pain
Year 2006
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This article is included in 3 Systematic reviews Systematic reviews (3 references)

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OBJECTIVE: This study was designed to investigate the hypoalgesic effects of self-applied transcutaneous electrical nerve stimulation (TENS) on chronic low-back pain (LBP) in a multiple sclerosis (MS) population. METHODS: Ninety participants with probable or definite MS (aged 21 to 78 y) presenting with chronic LBP were recruited and randomized into 3 groups (n = 30 per group): (1) low-frequency TENS group (4 Hz, 200 μs); (2) high-frequency TENS group (110 Hz, 200 μs); and (3) placebo TENS. Participants self-applied TENS for 45 minutes, a minimum of twice daily, for 6 weeks. Outcome measures were recorded at weeks 1, 6, 10, and 32. Primary outcome measures included: Visual Analog Scale for average LBP and the McGill Pain Questionnaire. Secondary outcome measures included: Visual Analog Scale for worst and weekly LBP, back and leg spasm; Roland Morris Disability Questionnaire; Barthel Index; Rivermead Mobility Index; Multiple Sclerosis Quality of Life-54 Instrument, and a daily logbook. Data were analyzed blind using parametric and nonparametric tests, as appropriate. RESULTS: Results indicated a statistically significant interactive effect between groups for average LBP (P = 0.008); 1-way analysis of covariance did not show any significant effects at any time point once a Bonferonni correction was applied (P &gt; 0.05). However, clinically important differences were observed in some of the outcome measures in both active treatment groups during the treatment and follow-up periods. DISCUSSION: Although not statistically significant, the observed effects may have implications for the clinical prescription and the use of TENS within this population. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

Primary study

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Transcutaneous electrical nerve stimulation [TENS] for chronic low back pain

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Journal Journal of Musculoskeletal Pain
Year 2005
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This article is included in 2 Systematic reviews Systematic reviews (2 references)

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Transcutaneous electrical nerve stimulation [TENS] has been in use for four decades for the treatment of pain. The study of this pain control modality has been limited. There have been small randomized studies which have tested older TENS modalities. These studies have had difficulty obtaining adequate results due to unreported drop out rates, small sample sizes, selection bias and study design. A large study with conventional, nu-waveform and acupuncture-type TENS as compared to sham treatment has been lacking. In this study, 324 patients with chronic lower back pain were randomly allocated to receive daily treatment of sham TENS [N = 83], conventional TENS [N = 84], acupuncture TENS [N = 78], or nu-wave TENS [N = 79]. After one month no significant effect of TENS treatment was detected on any of nine indicators of outcome measuring function, motion, or depression. There was a significant omnibus time effect [P < 0.0001] indicating improvement of all patients with time over the first month. There was no significant interactive effects of TENS treatment with time [P < 0.1180]. In this study, 324 patients with chronic low back pain with blinded randomization to one of four treatment groups revealed that TENS therapy is no more effective than placebo. © 2005 by The Haworth Press, Inc. All rights reserved.

Primary study

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Comparison of percutaneous electrical nerve stimulation with transcutaneous electrical nerve stimulation for long-term pain relief in patients with chronic low back pain.

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Journal Anesthesia and analgesia
Year 2004
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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The long-term effect of percutaneous electrical nerve stimulation (PENS) on chronic low back pain (LBP) is unclear. We evaluated the number of sessions for which PENS should be performed to alleviate chronic LBP and how long analgesia is sustained. Patients underwent treatment on a twice-weekly schedule for 8 wk. Group A (n = 18) received PENS for 8 wk, group B (n = 17) received PENS for the first 4 wk and transcutaneous electrical nerve stimulation (TENS) for the second 4 wk, and group C (n = 18) received TENS for 8 wk. Pain level, degree of physical impairment, and the daily intake of nonsteroidal antiinflammatory drugs (NSAIDs) were assessed before the first treatment, 3 days after Week 2, Week 4, and Week 8 treatments, and at 1 and 2 mo after the sessions. During PENS therapy, the pain level decreased significantly from Week 2 in Groups A and B (P &lt; 0.05 or 0.01), and physical impairment and required NSAIDs decreased significantly from Week 4 (P &lt; 0.05 or 0.01) in Group A but only at Week 4 in Group B (P &lt; 0.05 or 0.01). These effects were sustained until 1-mo follow-up (P &lt; 0.01) in Group A but not in Group B; these effects were not observed at 2-mo follow-up even in Group A. In Group C, pain level decreased significantly only at Week 8 (P &lt; 0.05). Our results indicate that repeated PENS is more effective than TENS for chronic LBP but must be continued to sustain the analgesic effect. IMPLICATIONS: A cumulative analgesic effect was observed in patients with chronic low back pain (LBP) after repeated percutaneous electrical nerve stimulation (PENS), but this effect gradually faded after the treatment was terminated. Results indicate that although PENS is effective for chronic LBP, treatments need to be continued to sustain analgesia.

Primary study

Unclassified

Efficacy of transcutaneous electrical nerve stimulation and percutaneous neuromodulation therapy in chronic low back pain

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Journal Journal of Back and Musculoskeletal Rehabilitation
Year 2004

This article is included in 4 Systematic reviews Systematic reviews (4 references)

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The study was designed to compare the efficacy of two different modalities of transcutaneous electrical nerve stimulation (conventional and low-frequency TENS) (C-TENS and Low-TENS) and percutaneous neuromodulation therapy (PNT) in the treatment of chronic low back pain. Sixty patients with chronic low back pain were randomly divided into four groups as placebo-TENS, C-TENS, Low-TENS, and PNT. Therapeutic modalities were administered for 2 weeks. The pre-treatment and post-treatment assessments were done by using the Visual Analog Scale for pain; Low Back Pain Outcome Scale and Oswestry Disability Index for functional disability; and Health Status Survey Short Form (SF-36) for quality of life. In placebo-TENS group only emotional role limitation score of SF-36 significantly decreased after the treatment. All measurements except emotional role limitation score of SF-36 significantly improved in C-TENS group after the treatment. In both of Low-TENS and PNT groups, all parameters were significantly improved by the treatment. TENS modalities and PNT were significantly more effective than the placebo-TENS. No significant difference was found between C-TENS and Low-TENS. PNT was significantly more effective than TENS in providing relief of activity pain and in improving general health, vitality and emotional role limitation scores of health quality.

Primary study

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One-shot percutaneous electrical nerve stimulation vs. transcutaneous electrical nerve stimulation for low back pain: comparison of therapeutic effects.

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Authors Hsieh RL , Lee WC
Journal American journal of physical medicine & rehabilitation
Year 2002
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This article is included in 1 Systematic review Systematic reviews (1 reference)

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OBJECTIVE: To investigate the therapeutic effects of one shot of low-frequency percutaneous electrical nerve stimulation one shot of transcutaneous electrical nerve stimulation in patients with low back pain. DESIGN: In total, 133 low back pain patients were recruited for this randomized, control study. Group 1 patients received medication only. Group 2 patients received medication plus one shot of percutaneous electrical nerve stimulation. Group 3 patients received medication plus one shot of transcutaneous electrical nerve stimulation. Therapeutic effects were measured using a visual analog scale, body surface score, pain pressure threshold, and the Quebec Back Pain Disability Scale. RESULTS: Immediately after one-shot treatment, the visual analog scale improved 1.53 units and the body surface score improved 3.06 units in the percutaneous electrical nerve stimulation group. In the transcutaneous electrical nerve stimulation group, the visual analog scale improved 1.50 units and the body surface score improved 3.98 units. The improvements did not differ between the two groups. There were no differences in improvement at 3 days or 1 wk after the treatment among the three groups. CONCLUSIONS: Simple one-shot treatment with percutaneous electrical nerve stimulation or transcutaneous electrical nerve stimulation provided immediate pain relief for low back pain patients. One-shot transcutaneous electrical nerve stimulation treatment is recommended due to the rarity of side effects and its convenient application.

Primary study

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Randomised controlled trial comparing the effectiveness of electroacupuncture and TENS for low back pain: A preliminary study for a pragmatic trial

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Journal Acupuncture in medicine : journal of the British Medical Acupuncture Society
Year 2002
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This article is included in 5 Systematic reviews Systematic reviews (5 references) 1 Broad synthesis Broad syntheses (1 reference)

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The objective of this study was to compare the effectiveness of electroacupuncture and TENS for low back pain when the electroacupuncture is applied in a clinically realistic manner. The study was designed as an evaluator-blinded randomised controlled trial (RCT). The study was performed at the Tsukuba College of Technology Clinic in Japan. Twenty subjects, who suffered from low back pain (LBP) without sciatica, were recruited, using leaflets in Tsukuba city. Subjects were allocated to either an electroacupuncture (EA) group (10 patients) or a transcutaneous electrical nerve stimulation (TENS) group (10 patients). The procedure for EA was in accordance with standard practice at our clinic. The main outcome measures were a pain relief scale (100mm visual analogue scale: VAS) and a LBP score recommended by the Japanese Orthopaedic Association (JOA Score). Mean VAS value during the 2-weeks experimental period of the EA group was significantly smaller than that of the TENS group (65mm vs 86mm; 95% CI, 4.126 - 37.953). JOA Score in the EA group improved significantly while that in the TENS group showed no change. Although some placebo effect may be included, EA appeared more useful than TENS in the short-term effect on low back pain. We suggest that more realistic acupuncture interventions based on standard practice should be employed in pragmatic RCTs.