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. 2018 Oct 10:11:2269-2278.
doi: 10.2147/JPR.S168297. eCollection 2018.

Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia

Carol Gt Vance  1 , Ruth L Chimenti  1 , Dana L Dailey  1 , Katherine Hadlandsmyth  2 , M Bridget Zimmerman  3 , Katharine M Geasland  1 , Jonathan M Williams  4 , Ericka N Merriwether  1   5 , Li Alemo Munters  4 , Barbara A Rakel  6 , Leslie J Crofford  4 , Kathleen A Sluka  1
Affiliations

Development of a method to maximize the transcutaneous electrical nerve stimulation intensity in women with fibromyalgia

Carol Gt Vance et al. J Pain Res. .

Abstract

Introduction: Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological intervention clinically used for pain relief. The importance of utilizing the adequate stimulation intensity is well documented; however, clinical methods to achieve the highest possible intensity are not established.

Objectives: Our primary aim was to determine if exposure to the full range of clinical levels of stimulation, from sensory threshold to noxious, would result in higher final stimulation intensities. A secondary aim explored the association of pain, disease severity, and psychological variables with the ability to achieve higher final stimulation intensity.

Methods: Women with fibromyalgia (N=143) were recruited for a dual-site randomized controlled trial - Fibromyalgia Activity Study with TENS (FAST). TENS electrodes and stimulation were applied to the lumbar area, and intensity was increased to sensory threshold (ST), then to "strong but comfortable" (SC1), then to "noxious" (N). This was followed by a reduction to the final stimulation intensity of "strong but comfortable" (SC2). We called this the Setting of Intensity of TENS (SIT) test.

Results: There was a significant increase from SC1 (37.5 mA IQR: 35.6-39.0) to SC2 (39.2 mA IQR: 37.1-45.3) (p<0.0001) with a mean increase of 1.7 mA (95% CI: 1.5, 2.2). Linear regression analysis showed that those with the largest increase between SC1 and N had the largest increase in SC2-SC1. Further, those with older age and higher anxiety were able to achieve greater increases in intensity (SC2-SC1) using the SIT test.

Conclusion: The SC2-SC1 increase was significantly associated with age and anxiety, with greater mean increases associated with older age and higher anxiety. Thus, although all patients may benefit from this protocol, older women and women with elevated anxiety receive the greatest benefit.

Keywords: TENS; dosage; fibromyalgia; pain; transcutaneous electrical nerve stimulation.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Regression of the difference in TENS intensities (mA) between “strong but comfortable 1” and “strong but comfortable 2” (SC2–SC1) on the difference between “strong but comfortable 1” and “noxious” for the lumbar region in (A) all subjects with fibromyalgia. Regression of the difference in TENS intensities (mA) between “strong but comfortable 1” and “strong but comfortable 2” (SC2–SC1) on the difference between “strong but comfortable 1” and “noxious” for the lumbar region in subjects with fibromyalgia by categories for (B) age, (C) PROMIS Anxiety with significant differences in slope, and (D) PCS with a nonsignificant difference. Abbreviations: PCS, Pain Catastrophizing Scale; PROMIS, Patient-Reported Outcomes Measurement Information System; TENS, Transcutaneous electrical nerve stimulation.
Figure 2
Figure 2
Regression of the difference in TENS intensities (mA) between “strong but comfortable 1” and “strong but comfortable 2” (SC2–SC1) on the difference between “strong but comfortable 1” and “noxious” for the lumbar region for variables with nonsignificant differences in slope between categories include (A) NRS pain at baseline, (B) BMI, (C) FIQR, and (D) PROMIS Depression. Abbreviations: BMI, body mass index; FIQR, the Revised Fibromyalgia Impact Questionnaire; NRS, Numeric Rating Scale; PROMIS, Patient-Reported Outcomes Measurement Information System; TENS, Transcutaneous electrical nerve stimulation.
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References

    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. J Pharmacol Exp Ther. 1999;289(2):840–846. - PubMed
    1. Kalra A, Urban MO, Sluka KA. Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS) J Pharmacol Exp Ther. 2001;298(1):257–263. - PubMed
    1. Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag. 2014;4(3):197–209. - PMC - PubMed
    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):157–165. - PubMed
    1. Rakel B, Frantz R. Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement. J Pain. 2003;4(8):455–464. - PubMed