Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2012 Mar 14;2012(3):CD006276.
doi: 10.1002/14651858.CD006276.pub3.

Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults

Adam Hurlow  1 , Michael I Bennett, Karen A Robb, Mark I Johnson, Karen H Simpson, Stephen G Oxberry
Affiliations
Meta-Analysis

Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults

Adam Hurlow et al. Cochrane Database Syst Rev. .

Abstract

Background: Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominantly used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role in pain management but the effectiveness of TENS is currently unknown. This is an update of the original review published in Issue 3, 2008.

Objectives: The aim of this systematic review was to determine the effectiveness of TENS for cancer-related pain in adults.

Search methods: The initial review searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED and PEDRO databases in April 2008. We performed an updated search of CENTRAL, MEDLINE, EMBASE, CINAHL and PEDRO databases in November 2011.

Selection criteria: We included only randomised controlled trials (RCTS) investigating the use of TENS for the management of cancer-related pain in adults.

Data collection and analysis: The search strategy identified a further two studies for possible inclusion. One of the review authors screened each abstract using a study eligibility tool. Where eligibility could not be determined, a second author assessed the full paper. One author used a standardised data extraction sheet to collect information on the studies and independently assess the quality of the studies using the validated five-point Oxford Quality Scale. The small sample sizes and differences in patient study populations of the three included studies (two from the original review and a third included in this update) prevented meta-analysis. For the original review the search strategy identified 37 possible published studies; we divided these between two pairs of review authors who decided on study selection; all four review authors discussed and agreed final scores.

Main results: Only one additional RCT met the eligibility criteria (24 participants) for this updated review. Although this was a feasibility study, not designed to investigate intervention effect, it suggested that TENS may improve bone pain on movement in a cancer population. The initial review identified two RCTs (64 participants) therefore this review now includes a total of three RCTs (88 participants). These studies were heterogenous with respect to study population, sample size, study design, methodological quality, mode of TENS, treatment duration, method of administration and outcome measures used. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-type TENS and sham in palliative care patients; this study was underpowered.

Authors' conclusions: Despite the one additional RCT, the results of this updated systematic review remain inconclusive due to a lack of suitable RCTs. Large multi-centre RCTs are required to assess the value of TENS in the management of cancer-related pain in adults.

PubMed Disclaimer

Conflict of interest statement

Karen Robb and Michael I Bennett are lead authors of included studies in this review; the remaining authors are not aware of any conflicts with this review.

Figures

1
1
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

Update of

References

References to studies included in this review

Bennett 2010 {published data only}
    1. Bennett MI, Johnson MI, Brown S, Searle RD, Radford H, Brown JM. Feasibility study of Transcutaneous Electrical Nerve Stimulation (TENS) for cancer bone pain. Journal of Pain 2010;11(4):351‐9. - PubMed
Gadsby 1997 {published data only}
    1. Gadsby JG, Franks A, Jarvis P, Dewhurst F. Acupuncture‐like transcutaneous electrical nerve stimulation within palliative care: a pilot study. Complementary Therapies in Medicine 1997;5:13‐8.
Robb 2007 {published data only}
    1. Robb KA, Newham DJ, Williams JE. Transcutaneous electrical nerve stimulation vs. transcutaneous spinal electroanalgesia for chronic pain associated with breast cancer treatments. Journal of Pain and Symptom Management 2007;33(4):410‐9. - PubMed

References to studies excluded from this review

Avellanosa 1982 {published data only}
    1. Avellanosa AM, West CR. Experience with transcutaneous electrical nerve stimulation for relief of intractable pain in cancer patients. Journal of Medicine 1982;13(3):203‐13. - PubMed
Bild 1990 {published data only}
    1. Bild E, Rosu V. The treatment of cancer. The contribution of transcutaneous electrical nerve stimulation. Revista medico‐chirurgicala a societatii de medici si naturalasti din iasi (iasi) 1990;94(2):407‐10. - PubMed
Bonakdar 2004 {published data only}
    1. Bonakdar R, Bresler DE, Borwick J. Do CAM therapies work for pain management?. Patient Care for the Nurse Practitioner 2004;September:9.
Cata 2004 {published data only}
    1. Cata JP, Cordella JV, Burton AW, Hassenbusch SJ, Weng H, Dougherty PM. Spinal cord stimulation relieves chemotherapy induced pain: a clinical case report. Journal of Pain and Symptom Management 2004;27(1):72‐8. - PubMed
Cooperman 1975 {published data only}
    1. Cooperman AM, Hall B, Sadar ES, Hardy Jr RW. Use of transcutaneous electrical stimulation in control of post‐operative pain. Surgical Forum 1975;26:77‐8. - PubMed
Crompton 1992 {published data only}
    1. Crompton AC, Johnson N, Dudek U, Batra N, Tucker A. Is transcutaneous electrical nerve stimulation of any value during cervical laser treatment. British Journal of Obstetrics and Gynaecology 1992;99(6):492‐4. - PubMed
De‐Pinto 2006 {published data only}
    1. De‐Pinto M, Dunbar PJ, Edwards WT. Pain management. Anesthesiology Clinics of North America 2006;24(1):19‐37. - PubMed
Dil'Din 1985 {published data only}
    1. Dil'Din AS, Tikhonova GP, Kozlov SV. Transcutaneous electrostimulation‐method leading to a permeation system of electroanalgesia in oncology patients. Voprosy Onkologii 1985;31:33‐6. - PubMed
Evtiukhin 1998 {published data only}
    1. Evtiukhin AI, Dunaeyskii IV, Shabut AM, Aleksandrov VA. The use of transcutaneous electrostimulation for pain relief in cancer patients. Voprosy Onkologii 1998;44(2):229‐33. - PubMed
Hakl 1989 {published data only}
    1. Hakl L, Umlauf R, Haklova O, Zahradka J. Promoting analgesia in cancer sufferers by using TENS through electroacupuncture at D14 and M36 points. Deutsche Zeitschrift Akupunk 1989;32:10‐21.
Hamza 1999 {published data only}
    1. Hamza MA, White PF, Ahmed HE, Ghoname EA. Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile. Anesthesiology 1999;91(5):1232‐8. - PubMed
Hasun 1988 {published data only}
    1. Hasun R, Marberger M. Transdermal electric pain control in urologic cancer patients. Schmerz Pain Douleur 1988;9(3):234‐8.
Hidderley 1997 {published data only}
    1. Hidderley M, Weinel E. Clinical practice. Effects of TENS applied to acupuncture points distal to a pain site. International Journal of Palliative Nursing 1997;3(4):185‐8, 190‐1. - PubMed
Kim 2005 {published data only}
    1. Kim PS. Interventional cancer pain therapies. Seminars in Oncology 2005; Vol. 32, issue 2:194‐9. - PubMed
Kleinkort 2005 {published data only}
    1. Kleinkort JA. Low‐level laser therapy: new possibilities in pain management and rehab. Orthopaedic Physical Therapy Practice 2005;17(1):48‐51. - PubMed
Lamer 1994 {published data only}
    1. Lamer TJ. Treatment of cancer‐related pain: when orally administered medications fail. Mayo Clinic Proceedings 1994;69(5):473‐80. - PubMed
Lange 1995 {published data only}
    1. Lange A. Physiotherapy in cancer treatment ‐ therapy for tumour or therapy limited to functional restriction due to malignant disease [Physiotherapie in der Onkologie ‐ Behandlung von tumor oder therapie‐bedingten Funktions ‐ storungen bei malignen Erkrankungen]. Krankengymnastique 1995;47(3):338.
Librach 1988 {published data only}
    1. Librach SL. The use of TENS for the relief of pain in palliative care. Palliative Medicine 1988;2:15‐20.
Long 1991 {published data only}
    1. Long DM. Fifteen years of Transcutaneous Electrical Stimulation for pain control. Stereotactic and Functional Neurosurgery 1991;56(1):2‐19. - PubMed
McCaffery 1992 {published data only}
    1. McCaffery M, Wolff M. Pain relief using cutaneous modalities, positioning and movement. Hospice Journal 1992;8(1/2):121‐53. - PubMed
Miguel 2000 {published data only}
    1. Miguel R. Interventional treatment of cancer pain: the fourth step in the WHO analgesic ladder. Cancer Control 2000;7(2):149‐56. - PubMed
Naveau 1992 {published data only}
    1. Naveau S, Barritault L, Zourabichvili O, Champagne C, Prieur G, Limoge A, et al. Analgesic effect of transcutaneous cranial electrostimulation in patients treated by Nd: YAG laser for cancer of the rectum. A double‐blind randomised trial. Gastroenerologie Clinique et Biologique 1992;16(1):8‐11. - PubMed
Oosterwijk 1994 {published data only}
    1. Oosterwijk RFA, Meyler WJ, Henley EJ, Scheer SS, Tannenbaum J. Pain control with TENS and team nerve stimulators: a review. Critical Reviews in Physical and Rehabilitation Medicine 1994;6(3):219‐57.
Ostrowski 1979 {published data only}
    1. Ostrowski MJ. Pain control in advanced malignant disease using transcutaneous nerve stimulation. The British Journal of Clinical Practice 1979;33(6):157‐62. - PubMed
Pan 2000 {published data only}
    1. Pan CX, Morrison RS, Ness J, Fugh‐Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnoea and nausea and vomiting near the end of life: a systematic review. Journal of Pain and Symptom Management 2000;20(5):374‐87. - PubMed
Patt 1990 {published data only}
    1. Patt RB. Non‐pharmacologic measures for controlling oncologic pain. The American Journal of Hospice and Palliative Care 1990;7(7):30‐7. - PubMed
Patt 1992 {published data only}
    1. Patt RB. Non‐pharmacologic measures for controlling oncologic pain. The American Journal of Hospice and Palliative Care 1992;9(6):41‐7. - PubMed
Picaza 1975 {published data only}
    1. Picaza JA, Cannon BW, Hunter SE. Pain suppression by peripheral nerve stimulation. Part 1. Observations with transcutaneous stimuli. Surgical Neurology 1975;4(4):105‐14. - PubMed
Rafter 1986 {published and unpublished data}
    1. Rafter J. TENS and cancer pain. Paper read to the Acupuncture Foundation of Canada on acupuncture and related techniques. November 1986.
Reuss 1985 {published data only}
    1. Reuss R, Meyer SC. The use of TENS in the management of cancer pain. Physical Therapy and Clinical Management 1985;5(5):26‐8.
Robb 2003 {published data only}
    1. Robb K. Chronic pain management in breast cancer patients. Chartered Society of Physiotherapy Annual Conference Proceedings. 2003:125.
Robb 2004 {published data only}
    1. Robb KA. Managing chronic pain in breast cancer survivors. PPA News 2004;17:26‐7.
Rutkowski 1980 {published data only}
    1. Rutkowski B, Kaczor T, Niedzialkowska T, Otto J. Electroanalalgesia in the treatment of pain in oncologic patients. Polski Tygodnik Lekarski 1980;35(48):1865‐6. - PubMed
Sang 2003 {published data only}
    1. Sang CN, Max MB, Gracely RH. Stability and reliability of detection thresholds for human A‐beta and A‐delta sensory afferents determined by cutaneous electrical stimulation. Journal of Pain and Symptom Management 2003;25(1):64‐73. - PubMed
Sharp 2003 {published data only}
    1. Sharp SM. Placebo controls in the evaluation of medical devices. Research Practitioner 2003;4(4):134‐43.
Sima 2009 {published data only}
    1. Sima L, Yin C. Efficacy of electroacupuncture for bone metastatic cancer patients with neuropathic pain: a randomized controlled trial. Journal of Clinical Oncology 2009;27(15s):9534.
Sloan 2004 {published data only}
    1. Sloan PA. The evolving role of interventional pain management in oncology. Journal of Supportive Oncology 2004;2(6):491‐503. - PubMed
Tonkin 1998 {published data only}
    1. Tonkin J. Breast cancer: easing the pain. Physiotherapy Frontline 1998;4(5):18.
Urba 1996 {published data only}
    1. Urba SG. Non‐pharmacologic pain management in terminal care. Clinics in Geriatric Medicine 1996;12(2):301‐11. - PubMed
Ventafridda 1979 {published data only}
    1. Ventafridda V. TENS in cancer pain. Advances in Pain Research and Therapies 1979;2:509‐15.
Weinstein 1994 {published data only}
    1. Weinstein SM. Cancer pain. Physical Medicine and Rehabilitation 1994;8(2):279‐96.
Wen 1977 {published data only}
    1. Wen HL. Cancer pain treated with acupuncture and electrical stimulation. Modern Medicine of Asia 1977;13:12‐6.

Additional references

Bjordal 2003
    1. Bjordal JM, Johnson MI, Ljunggreen AE. Transcutaneous Electrical Nerve Stimulation (TENS) can reduce postoperative analgesic consumption. A meta‐analysis with assessment of optimal treatment parameters for post‐op pain. European Journal of Pain 2003;7:181‐8. - PubMed
Brosseau 2003
    1. Brosseau L, Yonge KA, Robinson V, Marchand S, Judd M, Wells G, et al. TENS for the treatment of rheumatoid arthritis in the hand. Cochrane Database of Systematic Reviews 2003, Issue 2. [DOI: 10.1002/14651858.CD004377] - DOI - PMC - PubMed
DeSantana 2008
    1. DeSantana J, Walsh DM, Vance C, Rakel B, Sluka KA. Effectiveness of Transcutaneous Electrical Nerve Stimulation for treatment of hyperalgesia and pain. Current Rheumatology Reports 2008;10(6):492‐9. - PMC - PubMed
Dowswell 2009
    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, Issue 2. [DOI: 10.1002/14651858.CD007214.pub2] - DOI - PMC - PubMed
Filshie 2000
    1. Filshie J, Thompson JW. Acupuncture and TENS. Cancer pain management: a comprehensive approach. Oxford: Oxford University Press, 2000.
Jadad 1996
    1. Jadad JA, Moore AR, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Controlled Clinical Trials 1996;17:1‐12. - PubMed
Johnson 2001
    1. Johnson MI. Transcutaneous Electrical Nerve Stimulation (TENS) and TENS‐like devices: do they provide pain relief?. Pain Reviews 2001;8(3‐4):121‐58.
Johnson 2008a
    1. Johnson M. Transcutaneous Electrical Nerve Stimulation. In: Watson T editor(s). Electrotherapy: Evidence based practice. 12th Edition. Edinburgh: Churchill Livingstone, 2008.
Johnson 2008b
    1. Johnson M, Oxberry S, Robb K. Stimulation‐induced analgesia. In: Sykes N, Bennett M, Yuan CS editor(s). Cancer Pain. Vol. 2nd, London: Hodder Arnold, 2008.
Johnson 2011
    1. Johnson MI, Bjordal JM. Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain. Expert Review of Neurotherapeutics 2011;11(5):735‐53. - PubMed
Jones 2009
    1. Jones I, Johnson MI. Transcutaneous electrical nerve stimulation. Continuing Education in Anaesthesia, Critical Care & Pain 2009;9(4):130‐5.
Khadilkar 2008
    1. Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low‐back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD003008.pub3] - DOI - PMC - PubMed
Kroeling 2009
    1. Kroeling P, Gross A, Goldsmith CH, Burnie SJ, Haines T, Graham N, et al. Electrotherapy for neck pain. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD004251.pub4] - DOI - PubMed
Melzack 1965
    1. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;150:971‐99. - PubMed
Mulvey 2010
    1. Mulvey MR, Bagnall A‐M, Johnson MI, Marchant PR. Transcutaneous electrical nerve stimulation (TENS) for phantom pain and stump pain following amputation in adults. Cochrane Database of Systematic Reviews 2010, Issue 2. [DOI: 10.1002/14651858.CD007264.pub2] - DOI - PubMed
Nnoaham 2008
    1. Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD003222.pub2] - DOI - PubMed
Proctor 2009
    1. Proctor M, Farquhar C, Stones W, He L, Zhu X, Brown J. Transcutaneous electrical nerve stimulation for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD002123] - DOI - PMC - PubMed
Raphael 2010
    1. Raphael J, Hester J, Ahmedzai S, Barrie J, Farqhuar‐Smith P, Williams J, et al. Cancer pain: part 2: physical, interventional and complimentary therapies; management in the community; acute, treatment‐related and complex cancer pain: a perspective from the British Pain Society endorsed by the UK Association of Palliative Medicine and the Royal College of General Practitioners. Pain Medicine 2010;11:872–96. - PubMed
Reeve 1996
    1. Reeve J, Menon D, Corabian P. Transcutaneous Electrical Nerve Stimulation: a technology assessment. International Journal of Technology Assessment in Healthcare 1996;12:299‐324. - PubMed
Rutjes 2009
    1. Rutjes AWS, Nüesch E, Sterchi R, Kalichman L, Hendriks E, Osiri M, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2009, Issue 4. [DOI: 10.1002/14651858.CD002823.pub2] - DOI - PMC - PubMed
Searle 2008
    1. Searle RD, Bennett MI, Johnson MI, Callin S, Radford H. Letter to editor: transcutaneous electrical nerve stimulation (TENS) for cancer bone pain. Palliative Medicine 2008;22:878‐9. - PubMed
Simpson 2000
    1. Simpson K. Philosophy of cancer pain management. Cancer Pain Management: A Practical Approach. Vol. 1, Oxford: Oxford University Press, 2000.
Turk 1998
    1. Turk DC. Adaptation to metastatic cancer pain, regional/local cancer pain and non cancer pain: role of psychological and behavioural factors. Pain 1998;74:247‐56. - PubMed
Walsh 1997
    1. Walsh DM. TENS: clinical applications and related theory. 1st Edition. Edinburgh: Churchill Livingstone, 1997.
Walsh 2006
    1. Walsh DM, Howe TE, Johnson MI, Moran F, Sluka KA. Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database of Systematic Reviews 2009, Issue 2. [DOI: 10.1002/14651858.CD006142.pub2] - DOI - PubMed

Publication types