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Randomized Controlled Trial
. 2018 Dec;97(52):e13782.
doi: 10.1097/MD.0000000000013782.

Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation

Thomas Garaud  1 , Christine Gervais  2 , Barbara Szekely  1   2 , Mireille Michel-Cherqui  1   2 , Jean-François Dreyfus  3 , Marc Fischler  1
Affiliations
Randomized Controlled Trial

Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation

Thomas Garaud et al. Medicine (Baltimore). 2018 Dec.

Abstract

Background: Transcutaneous electrical nerve stimulation (TENS) is often used for the treatment of low-back pain (LBP). However, its effectiveness is controversial.

Objective: To determine the efficacy of TENS in the treatment LBP when associated to a therapeutic education program (TEP).

Design: Open randomized monocentric study.

Setting: University hospital between 2010 and 2014.

Patients: A total of 97 patients suffering from LBP.

Interventions: Routine care (TENS group) or routine care plus a therapeutic education program (TENS-TEP group) based on consultation support by a pain resource nurse.

Main outcome measures: EIFEL and Dallas Pain Questionnaire scores.

Results: Twenty-two patients (44%) were still assessable at the end-of-study visit, whereas 33 (70%) were assessable at the same time point in the TENS-TEP group (P = .013). The EIFEL score and the Dallas score had a similar evolution over time between groups (P = .18 and P = .50 respectively). Similarly, there were no significant differences between the groups with respect to resting pain scores (P = .94 for back pain and P = .16 for leg pain) and movement pain scores (P = .52 for back pain and P = .56 for leg pain). At Month 6, there was no significant difference between the groups (P = .85) with regard to analgesics and social impact. Two patients presented a serious adverse event during the study (one in each group) but non-attributable to the treatment studied.

Conclusion: This study does not support the use of TENS in the treatment of patients with chronic LBP even though patients benefited from a therapeutic education program by a pain resource nurse. However, the higher number of premature withdrawals in the TENS group may be due to early withdrawal of patients who did not experience improvement of their symptoms.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow chart, TENS: Group of patients treated with transcutaneous electrical nerve stimulation, TENS-TEP: Group of patients treated with transcutaneous electrical nerve stimulation in combination with a therapeutic education program.
Figure 2
Figure 2
Evolution of EIFEL score and Dallas Pain Questionnaire, TENS: Group of patients treated with transcutaneous electrical nerve stimulation, TENS-TEP: Group of patients treated with transcutaneous electrical nerve stimulation in combination with a therapeutic education program, PRN: Pain resource nurse, M1, M3, and M6: 1st, 3rd, and 6th month of treatment, respectively. PRN = pain resource nurse.
Figure 3
Figure 3
Evolution of pain scores, TENS: Group of patients treated with transcutaneous electrical nerve stimulation, TENS-TEP: Group of patients treated with transcutaneous electrical nerve stimulation in combination with a therapeutic education program, PRN: Pain resource nurse, M1, M3, and M6: 1st, 3rd, and 6th month of treatment, respectively. PRN = pain resource nurse.
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