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
. 2015 Jun 15;2015(6):CD006142.
doi: 10.1002/14651858.CD006142.pub3.

Transcutaneous electrical nerve stimulation for acute pain

Mark I Johnson  1 , Carole A Paley, Tracey E Howe, Kathleen A Sluka
Affiliations
Meta-Analysis

Transcutaneous electrical nerve stimulation for acute pain

Mark I Johnson et al. Cochrane Database Syst Rev. .

Abstract

Background: This is a second update of a Cochrane Review originally published in Issue 2, 2009. Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological agent, based on delivering low voltage electrical currents to the skin. TENS is used by people to treat a variety of pain conditions.

Objectives: To assess the analgesic effectiveness of TENS, as a sole treatment, for acute pain in adults.

Search methods: We searched the following databases up to 3 December 2014: the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; EMBASE; CINAHL; and AMED. We also checked the reference lists of included trials.

Selection criteria: We included randomised controlled trials (RCTs) of adults with acute pain (< 12 weeks) if they examined TENS given as a sole treatment and assessed pain with subjective pain scales. Trials were eligible if they compared TENS to placebo TENS, no treatment controls, pharmacological interventions or non-pharmacological interventions. We excluded trials on experimental pain, case reports, clinical observations, letters, abstracts or reviews. Also we excluded trials investigating the effect of TENS on pain during childbirth (labour), primary dysmenorrhoea or dental procedures. Studies where TENS was given with another treatment as part of the formal trial design were excluded. We did not restrict any articles based on language of publication.

Data collection and analysis: Two review authors independently assessed study eligibility and carried out study selection, data extraction, 'Risk of bias' assessment and analyses of data. We extracted data on the following: types of participants and pain condition, trial design and methods, treatment parameters, adverse effects, and outcome measures. We contacted trial authors for additional information if necessary.

Main results: We included 12 trials in the original review (2009) and included no further trials in the first update (2011). An additional seven new trials met the inclusion criteria in this second update. In total, we included 19 RCTs involving 1346 participants at entry, with 11 trials awaiting classification either because the full text was unavailable or information in the full text failed to clarify eligibility. We excluded most trials because TENS was given in combination with another treatment as part of the formal study design or TENS was not delivered using appropriate TENS technique. The types of acute pain included in this Cochrane Review were procedural pain, e.g. cervical laser treatment, venepuncture, screening flexible sigmoidoscopy and non-procedural pain, e.g. postpartum uterine contractions and rib fractures. We pooled data for pain intensity for six trials (seven comparisons) comparing TENS with placebo but the I(2) statistic suggested substantial heterogeneity. Mean difference (MD) with 95% confidence intervals (CIs) on a visual analogue scale (VAS, 100 mm) was -24.62 mm (95% CI -31.79 to -17.46) in favour of TENS. Data for the proportion of participants achieving ≥ 50% reduction in pain was pooled for four trials (seven comparisons) and relative risk was 3.91 (95% CI 2.42 to 6.32) in favour of TENS over placebo. We pooled data for pain intensity from five trials (seven comparisons) but the I(2) statistic suggested considerable heterogeneity. MD was -19.05 mm (95% CI -27.30 to -10.79) in favour of TENS using a random-effects model. It was not possible to pool other data. There was a high risk of bias associated with inadequate sample sizes in treatment arms and unsuccessful blinding of treatment interventions. Seven trials reported minor adverse effects, such as mild erythema and itching underneath the electrodes and participants disliking TENS sensation.

Authors' conclusions: This Cochrane Review update includes seven new trials, in addition to the 12 trials reviewed in the first update in 2011. The analysis provides tentative evidence that TENS reduces pain intensity over and above that seen with placebo (no current) TENS when administered as a stand-alone treatment for acute pain in adults. The high risk of bias associated with inadequate sample sizes in treatment arms and unsuccessful blinding of treatment interventions makes definitive conclusions impossible. There was incomplete reporting of treatment in many reports making replication of trials impossible.

PubMed Disclaimer

Conflict of interest statement

Mark I Johnson has no conflicts of interest to declare. Carole A Paley has no conflicts of interest to declare. Tracey E Howe has no conflicts of interest to declare. Kathleen A Sluka acts as a consultant for DJO, Inc. (declaration approved by the Cochrane Funding Arbiter).

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgments about each methodological quality item presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgments about each methodological quality item for each included trial.
4
4
Forest plot of comparison: 1 TENS versus placebo TENS, outcome: 1.1 Pain intensity (100 mm VAS).
5
5
Forest plot of comparison: 1 TENS versus placebo TENS, outcome: 1.2 > 50% reduction in pain.
6
6
Forest plot of comparison: 2 TENS versus no treatment control, outcome: 2.1 Pain intensity (100 mm VAS).
1.1
1.1. Analysis
Comparison 1: TENS versus placebo TENS, Outcome 1: Pain intensity (100 mm VAS)
1.2
1.2. Analysis
Comparison 1: TENS versus placebo TENS, Outcome 2: > 50% reduction in pain
2.1
2.1. Analysis
Comparison 2: TENS versus no treatment control, Outcome 1: Pain intensity (100 mm VAS)
3.1
3.1. Analysis
Comparison 3: Conventional TENS versus AL‐TENS, Outcome 1: > 50% reduction in pain
4.1
4.1. Analysis
Comparison 4: High pulse amplitude TENS versus low pulse amplitude TENS, Outcome 1: Pain intensity (100 mm VAS)
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Amer‐Cuenca 2011 {published data only}
    1. Amer-Cuenca JJ, Goicoechea C, Girona-López A, Andreu-Plaza JL, Palao-Román R, Martínez-Santa G, et al. Pain relief by applying transcutaneous electrical nerve stimulation (TENS) during unsedated colonoscopy: a randomized double-blind placebo-controlled trial. European Journal of Pain 2011;15(1):29-35. - PubMed
Cheing 2005 {published data only}
    1. Cheing GL, Luk ML. Transcutaneous electrical nerve stimulation for neuropathic pain. Journal of Hand Surgery - British Volume 2005;30(1):50-5. - PubMed
Coyne 1995 {published data only}
    1. Coyne PJ, MacMurren M, Izzo T, Kramer T. Transcutaneous electrical nerve stimulator for procedural pain associated with intravenous needlesticks. Journal of Intravenous Nursing 1995;18(5):263-7. - 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 & Gynaecology 1992;99(6):492-4. - PubMed
De Angelis 2003 {published data only}
    1. De Angelis C, Perrone G, Santoro G, Nofroni I, Zichella L. Suppression of pelvic pain during hysteroscopy with a transcutaneous electrical nerve stimulation device. Fertility & Sterility 2003;79(6):1422-7. - PubMed
de Sousa 2014 {published data only}
    1. Sousa L, Gomes-Sponholz FA, Nakano AMS. Transcutaneous electrical nerve stimulation for the relief of post-partum uterine contraction pain during breast-feeding: a randomized clinical trial. Journal of Obstetrics and Gynaecology Research 2014;40(5):1317-23. - PubMed
Ekblom 1987 {published data only}
    1. Ekblom A, Hansson P. Thermal sensitivity is not changed by acute pain or afferent stimulation. Journal of Neurology, Neurosurgery & Psychiatry 1987;50(9):1216-20. - PMC - PubMed
Gregorini 2010 {published data only}
    1. Gregorini C, Cipriano JG, De Aquino LM, Rodrigues Branco JN, Bernardelli GF. Short-duration transcutaneous electrical nerve stimulation in the postoperative period of cardiac surgery. Arquivos Brasileiros De Cardiologia 2010;94(3):325-31. - PubMed
Hansson 1983 {published data only}
    1. Hansson P, Ekblom A. Transcutaneous electrical nerve stimulation (TENS) as compared to placebo TENS for the relief of acute oro-facial pain. Pain 1983;15(2):157-65. - PubMed
Hruby 2006 {published data only}
    1. Hruby G, Ames C, Chen C, Yan Y, Sagar J, Baron P, et al. Assessment of efficacy of transcutaneous electrical nerve stimulation for pain management during office-based flexible cystoscopy. Urology 2006;67(5):914-7. - PubMed
Keskin 2012 {published data only}
    1. Keskin EA, Onur O, Keskin HL, Gumus II, Kafali H, Turhan N. Transcutaneous electrical nerve stimulation improves low back pain during pregnancy. Gynecologic & Obstetric Investigation 2012;74(1):76-83. - PubMed
Kim 2012 {published data only}
    1. Kim S, Park K, Son B, Jeon Y. The effect of transcutaneous electrical nerve stimulation on pain during venous cannulation. Current Therapeutic Research, Clinical and Experimental 2012;73(4-5):134-9. - PMC - PubMed
Limoges 2004 {published data only}
    1. Limoges MF, Rickabaugh B. Evaluation of TENS during screening flexible sigmoidoscopy. Gastroenterology Nursing 2004;27(2):61-8. - PubMed
Liu 1985 {published data only}
    1. Liu YC, Liao WS, Lien IN. Effect of transcutaneous electrical nerve stimulation for post-thoracotomic pain. Journal of the Formosan Medical Association 1985;84(7):801-9. - PubMed
Olsén 2007 {published data only}
    1. Olsén MF, Elden H, Janson ED, Lilja H, Stener-Victorin E. A comparison of high- versus low-intensity, high-frequency transcutaneous electric nerve stimulation for painful postpartum uterine contractions. Acta Obstetricia et Gynecologica Scandinavica 2007;86(3):310-4. - PubMed
Oncel 2002 {published data only}
    1. Oncel M, Sencan S, Yildiz H, Kurt N. Transcutaneous electrical nerve stimulation for pain management in patients with uncomplicated minor rib fractures. European Journal of Cardio-Thoracic Surgery 2002;22(1):13-7. - PubMed
Ordog 1987 {published data only}
    1. Ordog GJ. Transcutaneous electrical nerve stimulation versus oral analgesic: a randomized double-blind controlled study in acute traumatic pain. American Journal of Emergency Medicine 1987;5(1):6-10. - PubMed
Pitangui 2012 {published data only}
    1. Pitangui ACR, De Sousa L, Gomes FA, Ferreira CHJ, Nakano AMS. High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: a randomized, controlled trial. Journal of Obstetrics and Gynaecology Research 2012;38(7):980-7. - PubMed
Roche 1985 {published data only}
    1. Roche PA, Gijsbers K, Belch JJ, Forbes CD. Modification of haemophiliac haemorrhage pain by transcutaneous electrical nerve stimulation. Pain 1985;21(1):43-8. - PubMed

References to studies excluded from this review

Akhmadeeva 2010 {published data only}
    1. Akhmadeeva LR, Setchenkova NM, Magzhanov RV, Abdrashitova EV, Bulgakova AZ. Randomized blind placebo-controlled study of the effectiveness of transcutaneous adaptive electrostimulation in the treatment of nonspecific low back pain [Russian]. Zhurnal nevrologii i psikhiatrii i S.S. Korsakova/Ministerstvo zdravookhraneniia i meditsinskoĭ promyshlennosti Rossiĭskoĭ Federatsii, Vserossiĭskoe obshchestvo nevrologov [i] Vserossiĭskoe obshchestvo psikhiatrov 2010;110(4):57-62. - PubMed
Andersen 2009a {published data only}
    1. Andersen T, Christensen FB, Ernst C, Fruensgaard S, Østergaard J, Andersen JL et al. The effect of electrical stimulation on lumbar spinal fusion in older patients: a randomized, controlled, multi-center trial: part 1: functional outcome. Spine 2009;34(21):2241-7. - PubMed
Andersen 2009b {published data only}
    1. Andersen T, Christensen FB, Egund N, Ernst C, Fruensgaard S, Østergaard J, et al. The effect of electrical stimulation on lumbar spinal fusion in older patients: a randomized, controlled, multi-center trial: part 2: fusion rates. Spine 2009;34(21):2248-53. - PubMed
Barbarisi 2010 {published data only}
    1. Barbarisi M, Pace MC, Passavanti MB, Maisto M, Mazzariello L, Pota V et al. Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment. Clinical Journal of Pain 2010;26(7):567-72. - PubMed
Barker 2006 {published data only}
    1. Barker R, Lang T, Steinlechner B, Mora B, Heigel P, Gauss N, et al. Transcutaneous electrical nerve stimulation as prehospital emergency interventional care: treating acute pelvic pain in young women. Neuromodulation 2006;9(2):136-42. - PubMed
Baskurt 2006 {published data only}
    1. Baskurt Z, Baskurt F, Ozcan A, Yilmaz O. The immediate effects of heat and TENS on pressure pain threshold and pain intensity in patients with stage I shoulder impingement syndrome. Pain Clinic 2006;18(1):81-5.
Bertalanffy 2005 {published data only}
    1. Bertalanffy A, Kober A, Bertalanffy P, Gustorff B, Gore O, Adel S, et al. Transcutaneous electrical nerve stimulation reduces acute low back pain during emergency transport. Academic Emergency Medicine 2005;12(7):607-11. - PubMed
Celik 2013 {published data only}
    1. Celik EC, Erhan B, Gunduz B, Lakse E. The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury. Spinal Cord 2013;51(4):334-7. - PubMed
Chee 1986 {published data only}
    1. Chee EK, Walton H. Treatment of trigger points with microamperage transcutaneous electrical nerve stimulation (TENS)--(the Electro-Acuscope 80). Journal of Manipulative & Physiological Therapeutics 1986;9(2):131-4. - PubMed
Coletta 1988 {published data only}
    1. Coletta R, Maggiolo F, Di Tizio S. Etofenamate and transcutaneous electrical nerve stimulation treatment of painful spinal syndromes. International Journal of Clinical Pharmacology Research 1988;8(4):295-8. - PubMed
Doğu 2009 {published data only}
    1. Doğu B, Yilmaz F, Karan A, Ergöz E, Kuran B. Comparative the effectiveness of occlusal splint and TENS treatments on clinical findings and pain threshold of temporomandibular disorders secondary to bruxism. Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2009;55(1):1-7.
Durmus 2009 {published data only}
    1. Durmus D, Akyol Y, Alayli G, Tander B, Zahiroglu Y, Canturk F. Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain: a randomized controlled trial. Rheumatology International 2009;29(8):947-54. - PubMed
Ekblom 1985 {published data only}
    1. Ekblom A, Hansson P. Extrasegmental transcutaneous electrical nerve stimulation and mechanical vibratory stimulation as compared to placebo for the relief of acute oro-facial pain. Pain 1985;23(3):223-9. - PubMed
Eyigor 2012 {published data only}
    1. Eyigor C, Eyigor S, Kivilcim Korkmaz O. Are intra-articular corticosteroid injections better than conventional TENS in treatment of rotator cuff tendinitis in the short run? A randomized study. European Journal of Physical and Rehabilitation Medicine 2012;46(3):315-24. - PubMed
Fengler 2007 {published data only}
    1. Fengler RKB, Jacobs JWG, Bac M, Wijck AJM, Meeteren NLU. Action potential simulation (APS) in patients with fibromyalgia syndrome (FMS): a controlled single subject experimental design. Clinical Rheumatology 2007;26(3):322-9. - PubMed
Gemmell 2011 {published data only}
    1. Gemmell H, Hilland A. Immediate effect of electric point stimulation (TENS) in treating latent upper trapezius trigger points: a double blind randomised placebo-controlled trial. Journal of Bodywork and Movement Therapies 2011;15(3):348-54. - PubMed
Gül 2009 {published data only}
    1. Gül K, Onal SA. Comparison of non-invasive and invasive techniques in the treatment of patients with myofascial pain syndrome. Ağri Derneği'nin Yayin organidir 2009;21(3):104-12. - PubMed
Gupta 2002 {published data only}
    1. Gupta, AK, Gupta S, Meena, DS, Sharma U. Post-tonsillectomy pain: Different modes of pain relief. Indian Journal of Otolaryngology and Head and Neck Surgery 2002;54(2):136-9. - PMC - PubMed
Herman 1994 {published data only}
    1. Herman E, Williams R, Stratford P, Fargas-Babjak A, Trott M. A randomized controlled trial of transcutaneous electrical nerve stimulation (CODETRON) to determine its benefits in a rehabilitation program for acute occupational low back pain. Spine 1994;19(5):561-8. - PubMed
Izadpanah 2005 {published data only}
    1. Izadpanah A, Hosseini SV. Comparison of electrotherapy of hemorrhoids and Ferguson hemorrhoidectomy in a randomized prospective study. International Journal of Surgery 2005;3(4):258-62. - PubMed
Korkmaz 2010 {published data only}
    1. Korkmaz OK, Capaci K, Eyigor C, Eyigor S. Pulsed radiofrequency versus conventional transcutaneous electrical nerve stimulation in painful shoulder: a prospective, randomized study. Clinical Rehabilitation 2010;24(11):1000-8. - PubMed
Kumar 2014 {published data only}
    1. Kumar S, Raje A. Effect of progressive muscular relaxation exercises versus transcutaneous electrical nerve stimulation on tension headache: A comparative study. Hong Kong Physiotherapy Journal 2014;32(2):86-91.
Lang 2007 {published data only}
    1. Lang T, Barker R, Steinlechner B, Gustorff B, Puskas T, Gore O, et al. TENS relieves acute posttraumatic hip pain during emergency transport. Journal of Trauma 2007;62(1):184-8. - PubMed
Lee 1997 {published data only}
    1. Lee JC, Lin DT, Hong C-Z. The effectiveness of simultaneous thermotherapy with ultrasound and electrotherapy with combined AC and DC current on the immediate pain relief of myofascial trigger points. Journal of Musculoskeletal Pain 1997;5(1):81-90.
Lee 2012 {published data only}
    1. Lee J, Rakel B, Dailey D, Vance C, Broderick A, Sluka K, et al. The effectiveness of TENS for head and neck cancer pain and function: a randomized and placebo-controlled double blind pilot study. Journal of Pain 2012;13(4):S63.
Leo 1986 {published data only}
    1. Leo KC, Dostal WF, Bossen DG, Eldridge VL, Fairchild ML, Evans RE. Effect of transcutaneous electrical nerve stimulation characteristics on clinical pain. Physical Therapy 1986;66(2):200-5. - PubMed
Mora 2006 {published data only}
    1. Mora B, Giorni E, Dobrovits M, Barker R, Lang T, Gore C, et al. Transcutaneous electrical nerve stimulation: an effective treatment for pain caused by renal colic in emergency care. Journal of Urology 2006;175(5):1737-41. - PubMed
Murina 2008 {published data only}
    1. Murina F, Bianco V, Radici G, Felice R, Di Martino M, Nicolini U. Transcutaneous electrical nerve stimulation to treat vestibulodynia: a randomised controlled trial. British Journal of Obstetrics & Gynaecology 2008;115(9):1165-70. - PubMed
Myśliwiec 2011 {published data only}
    1. Myśliwiec A, Saulicz E, Kuszewski M, Kokosz M, Wolny T. Assessment of the influence of Saunders traction and transcutaneous electrical nerve stimulation on hand grip force in patients with neck pain. Ortopedia, Traumatologia, Rehabilitacja 2011;13(1):37-44. - PubMed
Peng‐fei 2011 {published data only}
    1. Peng-fei S, Yu-hua J. Pulsed radiofrequency versus conventional transcutaneous electrical nerve stimulation in painful shoulder: a prospective, randomized study - can you really have the conclusion? Clinical Rehabilitation 2011;25(9):856-7. - PubMed
Pope 1994 {published data only}
    1. Pope MH, Phillips RB, Haugh LD, Hsieh CY, MacDonald L, Haldeman S. A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine 1994;19(22):2571-7. - PubMed
Reichstein 2005 {published data only}
    1. Reichstein L, Labrenz S, Ziegler D, Martin S. Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation. Diabetologia 2005;48(5):824-8. - PubMed
Rodarti 2012 {published data only}
    1. Pitangui AC, Sousa L, Gomes FA, Ferreira CH, Nakano AM. High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: a randomized, controlled trial. Journal of Obstetrics and Gynaecology Research 2012;38(7):980-7. - PubMed
Rodríguez‐Fernández 2011 {published data only}
    1. Rodríguez-Fernández ÁL, Garrido-Santofimia V, Güeita-Rodríguez J, Fernández-de-las-Peñas C. Effects of burst-type transcutaneous electrical nerve stimulation on cervical range of motion and latent myofascial trigger point pain sensitivity. Archives of Physical Medicine and Rehabilitation 2011;92(9):1353-8. - PubMed
Sahin 2011 {published data only}
    1. Sahin N, Albayrak I, Ugurlu H. Effect of different transcutaneous electrical stimulation modalities on cervical myofascial pain syndrome. Journal of Musculoskeletal Pain 2011;19(1):18-23.
Solomon 1985 {published data only}
    1. Solomon S, Guglielmo KM. Treatment of headache by transcutaneous electrical stimulation. Headache 1985;25(1):12-5. - PubMed
Stratton 2009 {published data only}
    1. Stratton M, McPoil TG, Cornwall MW, Patrick K. Use of low-frequency electrical stimulation for the treatment of plantar fasciitis. Journal of the American Podiatric Medical Association 2009;99(6):481-8. - PubMed
Sunshine 1996 {published data only}
    1. Sunshine W, Field TM, Quintino O, Fierro K, Kuhn C, Burman I, et al. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. Journal of Clinical Rheumatology 1996;2(1):18-22. - PubMed
Taskaynatan 2007 {published data only}
    1. Taskaynatan MA, Ozgul A, Ozdemir A, Tan AK, Kalyon TA. Effects of steroid iontophoresis and electrotherapy on bicipital tendonitis. Journal of Musculoskeletal Pain 2007;15(4):47-54.
Tsai 2010 {published data only}
    1. Tsai C, Chang W, Lee J. Effects of short-term treatment with kinesiotaping for plantar fasciitis. Journal of Musculoskeletal Pain 2010;18(1):71-80.
Tulgar 1991a {published data only}
    1. Tulgar M, McGlone F, Bowsher D, Miles JB. Comparative effectiveness of different stimulation modes in relieving pain. Part I. A pilot study. Pain 1991;47(2):151-5. - PubMed
Tulgar 1991b {published data only}
    1. Tulgar M, McGlone F, Bowsher D, Miles JB. Comparative effectiveness of different stimulation modes in relieving pain. Part II. A double-blind controlled long-term clinical trial. Pain 1991;47(2):157-62. - PubMed
Wang 2009 {published data only}
    1. Wang ZX. Clinical observation on electroacupuncture at acupoints for treatment of senile radical sciatica [Chinese]. Zhongguo zhen jiu (Chinese Acupuncture & Moxibustion) 2009;29(2):126-8. - PubMed

References to studies awaiting assessment

Cambiaghi 2013 {published data only}
    1. Cambiaghi AS, Leao RBF, Alvarez AV, Nascimento PF. Transcutaneous electrical nerve stimulation can reduce pain during diagnostic hysteroscopy and endometrial biopsy: a randomized, controlled trial. Fertility and Sterility 2013;100(3):S377.
de Paiva Tosato 2007 {published data only}
    1. Paiva Tosato J, Biasotto-Gonzalez DA, Caria PHF. Effect of massage therapy and of transcutaneous electrical nerve stimulation on pain and electromyographic activity in patients with temporomandibular dysfunction [Portugese]. Fisioterapia e Pesquisa 2007;14(2):21-6.
França 2012 {published data only}
    1. França FR, Ramos LV, Burke TN, Caffaro RR, Marques AP. Lumbar stabilization and transcutaneous electrical nerve stimulation in lumbar disc herniation: Preliminary study. Annals of the Rheumatic Disease. Conference: Annual European Congress of Rheumatology of the European League Against Rheumatism, EULAR 2012;71(Suppl 3):757.
Hsueh 1997 {published data only}
    1. Hsueh TC, Cheng PT, Kuan TS, Hong CZ. The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points. American Journal of Physical Medicine & Rehabilitation 1997;76(6):471-6. - PubMed
Liebano 2013 {published data only}
    1. Liebano R, Galli T, Chiavegato, L. Effects of transcutaneous electrical nerve stimulation on pain, mobility and pulmonary function in kidney donors: a randomized, double-blind and controlled trial. Journal of Pain 2013;14(4):S91. - PMC - PubMed
Park 2014 {published data only}
    1. Park C, Han D. Intraoperative transcutaneous electric nerve stimulation for postoperative posterior neck pain after thyroidectomy: A randomized trial. Pain Practice 2014;14:94.
Rajpurohit 2010 {published data only}
    1. Rajpurohit B, Khatri SM, Metgud D, Bagewadi A. Effectiveness of transcutaneous electrical nerve stimulation and microcurrent electrical nerve stimulation in bruxism associated with masticatory muscle pain - a comparative study. Indian Journal of Dental Research 2010;21(1):104-6. - PubMed
Salvador 2005 {published data only}
    1. Salvador D, El Daher Neto PD, Ferrari FP. Application of muscle energy technique in garbage collectors with acute mechanical lumbar pain Portuguese [Portuguese]. Fisioterapia e Pesquisa 2005;12(2):20-7.
Salvino 2013 {published data only}
    1. Salvino D, Curcio M, Trimboli M, Paletta R, Mazza MR, Quattrone A, et al. Cutaneous allodynia influences the analgesic effect of transcutaneous electrical nerve stimulation therapy in headache sufferers. Cephalalgia 2013;33(8):197.
Silva 2012 {published data only}
    1. Silva MB, Melo PR, Oliveira NML, Crema E, Fernandes LFRM. Analgesic effect of transcutaneous electrical nerve stimulation after laparoscopic cholecystectomy. American Journal of Physical Medicine & Rehabilitation 2012;91(8):652-7. - PubMed
Treacy 2011 {published data only}
    1. Treacy K, Walsh DM, Kent L, McCrory L, Rendall J, Elborn JS, et al. Transcutaneous electrical nerve stimulation (TENS) for acute lung pain in cystic fibrosis. Journal of Cystic Fibrosis 2011;10:S66.

Additional references

Aarskog 2007
    1. Aarskog R, Johnson MI, Demmink JH, Lofthus A, Iversen V, Lopes-Martins R, et al. Is mechanical pain threshold after transcutaneous electrical nerve stimulation (TENS) increased locally and unilaterally? A randomized placebo-controlled trial in healthy subjects. Physiotherapy Research International 2007;12(4):251-63. - PubMed
Bennett 2011
    1. Bennett MI, Hughes N, Johnson MI. Methodological quality in randomised controlled trials of transcutaneous electric nerve stimulation for pain: low fidelity may explain negative findings. Pain 2011;152(6):1226-32. - PubMed
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 postoperative pain. European Journal of Pain 2003;7(2):181-8. - PubMed
Bjordal 2007
    1. Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE. Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials. BMC Musculoskeletal Disorders 2007;8:51. - PMC - PubMed
Boutron 2008
    1. Boutron I, Moher D, Altman DG, Schulz K, Ravaud P, CONSORT group. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Annals of Internal Medicine 2008;148(4):295-309. - PubMed
Carroll 1996
    1. Carroll D, Tramèr M, McQuay H, Nye B, Moore A. Randomization is important in studies with pain outcomes: systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain. British Journal of Anaesthesia 1996;77(6):798-803. - PubMed
Chen 2008
    1. Chen C, Tabasam G, Johnson MI. Does the pulse frequency of transcutaneous electrical nerve stimulation (TENS) influence hypoalgesia? A systematic review of studies using experimental pain and healthy human participants. Physiotherapy 2008;94(1):11-20.
Chen 2010a
    1. Chen CC, Johnson MI. An investigation into the hypoalgesic effects of high and low frequency transcutaneous electrical nerve stimulation (TENS) on experimentally-induced blunt pressure pain in healthy human participants. Journal of Pain 2010;11(1):53-61. - PubMed
Chen 2010b
    1. Chen CC, Johnson MI. A comparison of transcutaneous electrical nerve stimulation (TENS) at 3 and 80 pulses per second on cold-pressor pain in healthy human participants. Clinical Physiology and Functional Imaging 2010;30(4):260-8. - PubMed
Chen 2011
    1. Chen CC, Johnson MI. Differential frequency effects of strong non-painful transcutaneous electrical nerve stimulation (TENS) on experimentally-induced ischaemic pain in healthy human participants. Clinical Journal of Pain 2011;27(5):434-41. - PubMed
Claydon 2008
    1. Claydon LS, Chesterton LS, Barlas P, Sim J. Effects of simultaneous dual-site TENS stimulation on experimental pain. European Journal of Pain 2008;12(6):696-704. - PubMed
Claydon 2011
    1. Claydon LS, Chesterton LS, Barlas P, Sim J. Dose-specific effects of transcutaneous electrical nerve stimulation (TENS) on experimental pain: a systematic review. Clinical Journal of Pain 2011;27(7):635–47. - PubMed
DeSantana 2008
    1. DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain. Current Rheumatology Reports 2008;10(6):492–9. - PMC - PubMed
Deyo 1990
    1. Deyo RA, Walsh NE, Schoenfeld LS, Ramamurthy S. Can trials of physical treatments be blinded? The example of transcutaneous electrical nerve stimulation for chronic pain. American Journal of Physical Medicine and Rehabilitation 1990;69(1):6-10. - PubMed
Dowswell 2009
    1. Dowswell T, Bedwell C, Lavender T, Neilson JP. Transcutaneous electrical nerve stimulation (TENS) for pain management in labour. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No: CD007214. [DOI: 10.1002/14651858.CD007214.pub2] - DOI - PMC - PubMed
Francis 2011
    1. Francis RP, Johnson MI. The characteristics of acupuncture-like transcutaneous electrical nerve stimulation (acupuncture-like TENS): a literature review. Acupuncture and Electrotherapeutics Research 2011;36(3-4):231-58. - PubMed
Freynet 2010
    1. Freynet A, Falcoz PE. Is transcutaneous electrical nerve stimulation effective in relieving postoperative pain after thoracotomy? Interactive Cardiovascular Thoracic Surgery 2010;10(2):283-8. - PubMed
Garrison 1994
    1. Garrison DW, Foreman RD. Decreased activity of spontaneous and noxiously evoked dorsal horn cells during transcutaneous electrical nerve stimulation (TENS). Pain 1994;58(3):309-15. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Houghton 2010
    1. Houghton P, Nussbaum E, Hoens A. Electrophysical agents - Contraindications and precautions: an evidence-based approach to clinical decision making in physical therapy. Physiotherapy Canada 2010;62(5):1-80. - PMC - PubMed
Hrobjartsson 2007
    1. Hrobjartsson A, Forfang E, Haahr MT, Als-Nielsen B, Brorson S. Blinded trials taken to the test: an analysis of randomized clinical trials that report tests for the success of blinding. International Journal of Epidemiology 2007;36(3):654-63. - PubMed
Jadad 1996
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials 1996;17(1):1-12. - PubMed
Johnson 1991
    1. Johnson MI, Ashton CH, Thompson JW. An in-depth study of long-term users of transcutaneous electrical nerve stimulation (TENS). Implications for clinical use of TENS. Pain 1991;44(3):221-9. - PubMed
Johnson 1999
    1. Johnson MI, Tabasam G. A double blind placebo controlled investigation into the analgesic effects of interferential currents (IFC) and transcutaneous electrical nerve stimulation (TENS) on cold induced pain in healthy subjects. Physiotherapy Theory and Practice 1999;15(4):217-33.
Johnson 2007
    1. Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain 2007;130(1-2):157-65. - PubMed
Johnson 2010
    1. Johnson MI, Walsh DM. Pain: continued uncertainty of TENS' effectiveness for pain relief. Nature Reviews Rheumatology 2010;6(6):314-6. - PubMed
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
Johnson 2014
    1. Johnson MI. Transcutaneous Electrical Nerve Stimulation (TENS). Research to Support Clinical Practice. Oxford: Oxford University Press, 2014.
Kalra 2001
    1. Kalra A, Urban MO, Sluka KA. Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS). Journal of Pharmacology and Experimental Therapeutics 2001;298(1):257-63. - PubMed
Leonard 2010
    1. Leonard G, Goffaux P, Marchand S. Deciphering the role of endogenous opioids in high-frequency TENS using low and high doses of naloxone. Pain 2010;151(1):215-9. - PubMed
Léonard 2011
    1. Léonard G, Cloutier C, Marchand S. Reduced analgesic effect of acupuncture-like TENS but not conventional TENS in opioid-treated patients. Journal of Pain 2011;12(2):213-21. - PubMed
Levin 1993
    1. Levin MF, Hui-Chan CW. Conventional and acupuncture-like transcutaneous electrical nerve stimulation excite similar afferent fibers. Archives of Physical Medicine and Rehabilitation 1993;74(1):54-60. - PubMed
Liebano 2011
    1. Liebano RE, Rakel B, Vance CG, Walsh DM, Sluka KA. An investigation of the development of analgesic tolerance to TENS in humans. Pain 2011;152(2):335-42. - PMC - PubMed
Melzack 1965
    1. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;150(3699):971-9. - PubMed
Merskey 1994
    1. Merskey H, Bogduk N (editors). Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. 2nd edition. Seattle: IASP Press, 1994.
Nnoaham 2008
    1. Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No: CD003222. [DOI: 10.1002/14651858.CD003222.pub2] - DOI - PubMed
Proctor 2002
    1. Proctor ML, Smith CA, Farquhar CM, Stones RW. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No: CD002123. [DOI: 10.1002/14651858.CD002123] - DOI - PMC - PubMed
Radhakrishnan 2003
    1. Radhakrishnan R, King EW, Dickman JK, Herold CA, Johnston NF, Spurgin ML, et al. Spinal 5-HT(2) and 5-HT(3) receptors mediate low, but not high, frequency TENS-induced antihyperalgesia in rats. Pain 2003;105(1-2):205-13. - PMC - PubMed
Radhakrishnan 2005
    1. Radhakrishnan R, Sluka KA. Deep tissue afferents, but not cutaneous afferents, mediate transcutaneous electrical nerve stimulation-induced antihyperalgesia. Journal of Pain 2005;6(10):673-80. - PubMed
Rakel 2010
    1. Rakel B, Cooper N, Adams HJ, Messer BR, Frey Law LA, Dannen DR, et al. A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment. Journal of Pain 2010;11(3):230-8. - PMC - PubMed
RevMan 2014 [Computer program]
    1. The Nordic Cochrane Centre; The Cochrane Collaboration Review Manager. Version 5.3. Copenhagen: The Nordic Cochrane Centre; The Cochrane Collaboration, 2014.
Sbruzzi 2012
    1. Sbruzzi G, Silveira SA, Silva DV, Coronel CC, Plentz RD. Transcutaneous electrical nerve stimulation after thoracic surgery: systematic review and meta-analysis of 11 randomized trials. Revista Brasileira de Cirurgia Cardiovascular 2012;27(1):75-87. - PubMed
Schug 2014
    1. Schug SA, Watson D, Pogatzki-Zahn EM. Acute pain. In: Griensven H, Strong J, Unrih AM, editors(s). Pain. A Textbook for Health Professionals. 2 edition. Edinburgh: Churchill Livingstone Elsevier, 2014:395-405.
Sluka 1999
    1. Sluka KA, Deacon M, Stibal A, Strissel S, Terpstra A. Spinal blockade of opioid receptors prevents the analgesia produced by TENS in arthritic rats. Journal of Pharmacology and Experimental Therapeutics 1999;289(2):840-6. - PubMed
Sluka 2013
    1. Sluka KA, Bjordal JM, Marchand S, Rakel BA. What makes transcutaneous electrical nerve stimulation work? Making sense of the mixed results in the clinical literature. Physical Therapy 2013;93(10):1397-402. - PMC - PubMed
Strong 2002
    1. Strong J. Chronic pain problems. In: Strong J, Unruh A, Wright A, Baxter GD, editors(s). Pain: a Textbook for Therapists. Edinburgh: Churchill Livingstone, 2002:397-410.
Tong 2007
    1. Tong KC, Lo SK, Cheing GL. Alternating frequencies of transcutaneous electric nerve stimulation: does it produce greater analgesic effects on mechanical and thermal pain thresholds? Archives of Physical Medicine and Rehabilitation 2007;88(10):1344-9. - PubMed

References to other published versions of this review

Walsh 2009
    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. Art. No: CD006142. [DOI: 10.1002/14651858.CD006142.pub2] - DOI - PubMed

Publication types