Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain

Abstract

Transcutaneous electrical nerve stimulation (TENS) is a nonpharmacologic treatment for pain relief. TENS has been used to treat a variety of painful conditions. This review updates the basic and clinical science regarding the use of TENS that has been published in the past 3 years (ie, 2005-2008). Basic science studies using animal models of inflammation show changes in the peripheral nervous system, as well as in the spinal cord and descending inhibitory pathways, in response to TENS. Translational studies show mechanisms to prevent analgesic tolerance to repeated application of TENS. This review also highlights data from recent randomized, placebo-controlled trials and current systematic reviews. Clinical trials suggest that adequate dosing, particularly intensity, is critical to obtaining pain relief with TENS. Thus, evidence continues to emerge from both basic science and clinical trials supporting the use of TENS for the treatment of a variety of painful conditions while identifying strategies to increase TENS effectiveness.

Figure 1

Schematic diagram showing potential pathways activated by low-frequency (LF) or high-frequency (HF) transcutaneous electrical nerve stimulation (TENS). Projections from the ventrolateral periaqueductal gray (PAG) send input to the rostroventral medial medulla (RVM), which in turn projects to the spinal cord to produce analgesia. Receptors known to be involved in the analgesia produced by TENS are listed for each site. 5HT—serotonin; ASP—aspartate; GABA—γ-aminobutyric acid; GLU—glutamate; M—muscarinic receptor.