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Meta-Analysis
. 2009 Apr 15:(2):CD007214.
doi: 10.1002/14651858.CD007214.pub2.

Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour

Therese Dowswell  1 , Carol Bedwell, Tina Lavender, James P Neilson
Affiliations
Meta-Analysis

Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour

Therese Dowswell et al. Cochrane Database Syst Rev. .

Abstract

Background: Transcutaneous nerve stimulation (TENS) has been proposed as a means of reducing pain in labour. The TENS unit emits low-voltage electrical impulses which vary in frequency and intensity. During labour, TENS electrodes are generally placed on the lower back, although TENS may be used to stimulate acupuncture points or other parts of the body. The physiological mechanisms whereby TENS relieves pain are uncertain. The TENS unit is frequently operated by women, which may increase sense of control in labour.

Objectives: To assess the effects of TENS on pain in labour.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2008).

Selection criteria: Randomised controlled trials comparing women receiving TENS for pain relief in labour versus routine care, alternative pharmacological methods of pain relief, or placebo devices. We included all types of TENS machines.

Data collection and analysis: Two review authors assessed for inclusion all trials identified by the search strategy, carried out data extraction and assessed risk of bias. We have recorded reasons for excluding studies.

Main results: The search identified 25 studies; we excluded six and included 19 studies including 1671 women. Fifteen examined TENS applied to the back, two to acupuncture points and two to the cranium. Overall, there was little difference in pain ratings between TENS and control groups, although women receiving TENS to acupuncture points were less likely to report severe pain (risk ratio 0.41, 95% confidence interval 0.32 to 0.55). The majority of women using TENS said they would be willing to use it again in a future labour. Where TENS was used as an adjunct to epidural analgesia there was no evidence that it reduced pain. There was no consistent evidence that TENS had any impact on interventions and outcomes in labour. There was little information on outcomes for mothers and babies. No adverse events were reported.

Authors' conclusions: There is only limited evidence that TENS reduces pain in labour and it does not seem to have any impact (either positive or negative) on other outcomes for mothers or babies. The use of TENS at home in early labour has not been evaluated. TENS is widely available in hospital settings and women should have the choice of using it in labour.

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Figures

Figure 1
Figure 1. Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies
Figure 2
Figure 2. Risk of bias summary: review authors’ judgements about each risk of bias item for each included study
See this image and copyright information in PMC

References

References to studies included in this review

    1. Bundsen P, Ericson K, Peterson LE, Thiringer K. Pain relief in labor by transcutaneous electrical nerve stimulation. Testing of a modified stimulation technique and evaluation of the neurological and biochemical condition of the newborn infant. Acta Obstetricia et Gynecologica Scandinavica. 1982;61(2):129–36. - PubMed
    1. Champagne C, Papiernik E, Thierry JP, Noviant Y. Transcutaneous cranial electrical stimulation by Limoge currents during labour. Annales Francaises d Anesthesie et de Reanimation. 1984;3:405–13. - PubMed
    1. Chao AS, Chao A, Wang TH, Chang YC, Peng HH, Chang SD, et al. Pain relief by applying transcutaneous electrical nerve stimulation (tens) on acupuncture points during the first stage of labor: a randomized double-blind placebo-controlled trial. Pain. 2007;127(3):214–20. - PubMed
    1. de Orange FA, Ramos de Amorim MM, Lima L. The use of transcutaneous nerve stimulation for pain relief during labor in a teaching hospital: a randomized controlled trial [Uso da eletroestimulacao transcutanea para alivio da dor durante o trabalho de parto em uma maternidade–escola: ensaio clinico controlado] Revista Brasileira de Ginecologia e Obstetricia. 2003;25(1):45–52.

    1. *

    2. Harrison RF, Woods T, Shore M, Mathews G, Unwin A. Pain relief in labour using transcutaneous electrical nerve stimulation (TENS). A TENS/TENS placebo controlled study in two parity groups. British Journal of Obstetrics and Gynaecology. 1986;93:739–46. - PubMed

References to studies excluded from this review

    1. Anonymous The study of the effect of transcutaneous electrical nerve stimulation (TENS) in reduction of labour pain and its duration; 12th International Congress World Confederation for Physical Therapy; Washington, DC, USA. 1995 June 25-30.p. 581.
    1. Canino A, Caccamo G, Zampetti A. TENS efficacy in the antalgic treatment in a trauma of caesarean section [Valutazione dell’efficacia della TENS come terapia antalgica nel trauma da taglio cesareo] La Riabilitazione. 1987;20(2):113–20.
    1. Chia YT, Arulkumaran S, Chua S, Ratnam SS. Effectiveness of transcutaneous electric nerve stimulator for pain relief in labour. Asia-Oceania Journal of Obstetrics and Gynaecology. 1990;16:145–51. - PubMed
    1. Dunn PA, Rogers D, Halford K. Transcutaneous electrical nerve stimulation at acupuncture points in the induction of uterine contractions. Obstetrics & Gynecology. 1989;73:286–90. - PubMed
    1. Erkkola R, Pikkola P, Kanto J. Transcutaneous nerve stimulation for pain relief during labour. A controlled study. Annales Chirurgiae Gynaecologiae. 1980;69:273–7. - PubMed

References to studies awaiting assessment

    1. Knobel R, Radunz V, Carraro TE. Use of transcutaneous electric nerve stimulation for pain relief in labour: a possible way to care the child-bearer [Utilizacao de estimulacao eletrica transcutanea para alivio da dor no trabalho de parto: um modo possivel para o cuidado a parturiente] Texto Contexto-Enfermagem. 2005;14(2):229–36.

Additional references

    1. Anim-Somuah M, Smyth RMD, Howell CJ. Epidural versus non-epidural or no analgesia in labour. Cochrane Database of Systematic Reviews. 2005;(4) DOI: 10.1002/14651858.CD000331.pub2. - PubMed
    1. Augustinsson LE, Bohlin P, Bundsen P, Carlsson CA, Forssman L, Sjoberg P, et al. Pain relief during delivery by transcutaneous electrical nerve stimulation. Pain. 1977;4(1):59–65. - PubMed
    1. Barragán Loayza IM, Solà I, Juandó Prats C. Biofeedback for pain management during labour. Cochrane Database of Systematic Reviews. 2011;(6) DOI: 10.1002/14651858.CD006168.pub2. - PubMed
    1. Brucker MC. Nonpharmaceutical methods for relieving pain and discomfort during pregnancy. MCN, American Journal of Maternal Child Nursing. 1984;9(6):390–4. - PubMed
    1. Bundsen P, Peterson LE, Selstam U. Pain relief in labor by transcutaneous electrical nerve stimulation. A prospective matched study. Acta Obstetricia et Gynecologica Scandinavica. 1981;60(5):459–68. - PubMed

References to other published versions of this review

    1. Dowswell T, Bedwell C, Lavender T, Neilson JP. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database of Systematic Reviews. 2009;(2) DOI: 10.1002/14651858.CD007214.pub2. - PMC - PubMed

    1. * Indicates the major publication for the study