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Hypoalgesia in Response to Transcutaneous Electrical Nerve Stimulation (TENS) Depends on Stimulation Intensity

      Abstract

      Transcutaneous electrical nerve stimulation (TENS) is an electrophysical modality used for pain management. This study investigated the dose response of different TENS intensities on experimentally induced pressure pain. One hundred and thirty TENS naïve healthy individuals (18–64 years old; 65 males, 65 females) were randomly allocated to 5 groups (n = 26 per group): Strong Non Painful TENS; Sensory Threshold TENS; Below Sensory Threshold TENS; No Current Placebo TENS; and Transient Placebo TENS. Active TENS (80 Hz) was applied to the forearm for 30 minutes. Transient Placebo TENS was applied for 42 seconds after which the current amplitude automatically reset to 0 mA. Pressure pain thresholds (PPT) were recorded from 2 points on the hand and forearm before and after TENS to measure hypoalgesia. There were significant differences between groups at both the hand and forearm (ANOVA; P = .005 and .002). At 30 minutes, there was a significant hypoalgesic effect in the Strong Non Painful TENS group compared to: Below Sensory Threshold TENS, No Current Placebo TENS and Transient Placebo TENS groups (P < .0001) at the forearm; Transient Placebo TENS and No Current Placebo TENS groups at the hand (P = .001). There was no significant difference between Strong Non Painful TENS and Sensory Threshold TENS groups. The area under the curve for the changes in PPT significantly correlated with the current amplitude (r2 = .33, P = .003). These data therefore show that there is a dose-response effect of TENS with the largest effect occurring with the highest current amplitudes.

      Perspective

      This study shows a dose response for the intensity of TENS for pain relief with the strongest intensities showing the greatest effect; thus, we suggest that TENS intensity should be titrated to achieve the strongest possible intensity to achieve maximum pain relief.

      Key words

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      References

        • Aarskog R.
        • Johnson M.I.
        • Demmink J.H.
        • Lofthus A.
        • Iversen V.
        • Lopes-Martins R.
        • Joensen J.
        • Bjordal J.M.
        Is mechanical pain threshold after transcutaneous electrical nerve stimulation (TENS) increased locally and unilaterally? A randomized placebo-controlled trial in healthy subjects.
        Physiother Res Int. 2007; 12: 251-263
        • Bjordal J.M.
        • Johnson M.I.
        • Ljunggreen A.E.
        Transcutaneous electrical nerve stimulation (TENS) can reduce postoperative analgesic consumption. A meta-analysis with assessment of optimal treatment parameters for postoperative pain.
        Eur J Pain. 2003; 7: 181-188
        • Brown L.
        • Tabasam G.
        • Bjordal J.M.
        • Johnson M.I.
        An investigation into the effect of electrode placement of transcutaneous electrical nerve stimulation (TENS) on experimentally induced ischemic pain in healthy human participants.
        Clin J Pain. 2007; 23: 735-743
        • Chen C.C.
        • Johnson M.I.
        An investigation into the effects of frequency-modulated transcutaneous electrical nerve stimulation (TENS) on experimentally-induced pressure pain in healthy human participants.
        J Pain. 2009; 10: 1029-1037
        • Chen C.C.
        • Johnson M.I.
        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.
        J Pain. 2010; 11: 53-61
        • Chesterton L.S.
        • Barlas P.
        • Foster N.E.
        • Lundeberg T.
        • Wright C.C.
        • Baxter G.D.
        Sensory stimulation (TENS): Effects of parameter manipulation on mechanical pain thresholds in healthy human subjects.
        Pain. 2002; 99: 253-262
        • Chesterton L.S.
        • Sim J.
        • Wright C.C.
        • Foster N.E.
        Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters.
        Clin J Pain. 2007; 23: 760-766
        • Claydon L.S.
        • Chesterton L.S.
        • Barlas P.
        • Sim J.
        Effects of simultaneous dual-site TENS stimulation on experimental pain.
        Eur J Pain. 2008; 12: 696-704
        • Cowan S.J.
        • McKenna J.
        • McCrum-Gardner E.
        • Johnson M.I.
        • Sluka K.A.
        • Walsh D.M.
        An investigation of the hypoalgesic effects of TENS delivered by a glove electrode.
        J Pain. 2009; 10: 694-701
        • Coyne P.J.
        • MacMurren M.
        • Izzo T.
        • Kramer T.
        Transcutaneous electrical nerve stimulator for procedural pain associated with intravenous needlesticks.
        J Intraven Nurs. 1995; 18: 263-267
        • De Angelis C.
        • Perrone G.
        • Santoro G.
        • Nofroni I.
        • Zichella L.
        Suppression of pelvic pain during hysteroscopy with a transcutaneous electrical nerve stimulation device.
        Fertil Steril. 2003; 79: 1422-1427
        • Deyo R.A.
        • Walsh N.E.
        • Schoenfeld L.S.
        • Ramamurthy S.
        Can trials of physical treatments be blinded? The example of transcutaneous electrical nerve stimulation for chronic pain.
        Am J Phys Med Rehabil. 1990; 69: 6-10
        • Kalra A.
        • Urban M.O.
        • Sluka K.A.
        Blockade of opioid receptors in rostral ventral medulla prevents antihyperalgesia produced by transcutaneous electrical nerve stimulation (TENS).
        J Pharmacol Exp Ther. 2001; 298: 257-263
        • Khadilkar A.
        • Odebiyi D.O.
        • Brosseau L.
        • Wells G.A.
        Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain.
        Cochrane Database of Systematic Reviews. 2008;
        • Lazarou L.
        • Kitsios A.
        • Lazarou I.
        • Sikaras E.
        • Trampas A.
        Effects of intensity of Transcutaneous Electrical Nerve Stimulation (TENS) on pressure pain threshold and blood pressure in healthy humans: A randomized, double-blind, placebo-controlled trial.
        Clin J Pain. 2009; 25: 773-780
        • Lehmann T.R.
        • Russell D.W.
        • Spratt K.F.
        • Colby H.
        • Liu Y.K.
        • Fairchild M.L.
        • Christensen S.
        Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients.
        Pain. 1986; 26: 277-290
        • Nnoaham K.E.
        • Kumbang J.
        Transcutaneous electrical nerve stimulation (TENS) for chronic pain.
        Cochrane Database of Systematic Reviews. 2008;
      1. Pantaleão MA, Laurino MF, Gallego NLG, Cabral CMN, Walsh DM, Rakel B, Vance C, Sluka KA, Liebano RE: An investigation of the effect of adjusting pulse amplitude during TENS application. Proceedings of the International Association for the Study of Pain 13th World Congress on Pain, Montreal, 2010.

        • Rakel B.
        • Frantz R.
        Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement.
        J Pain. 2003; 4: 455-464
        • Rakel B.
        • Cooper N.
        • Adams H.J.
        • Messer B.R.
        • Frey Law L.A.
        • Dannen D.R.
        • Miller C.A.
        • Polehna A.C.
        • Ruggle R.C.
        • Vance C.G.T.
        • Walsh D.M.
        • Sluka K.A.
        A new transient sham TENS device allows for investigator blinding while delivering a true placebo treatment.
        J Pain. 2010; 1: 230-238
        • Sluka K.A.
        • Walsh D.M.
        Transcutaneous Electrical Nerve Stimulation and Interferential Therapy.
        in: Sluka K.A. Mechanisms and Management of Pain for the Physical Therapist. 1st ed. IASP Press, Seattle, WA2009: 167-190
        • Walsh D.M.
        • Howe T.E.
        • Johnson M.I.
        • Sluka K.A.
        Transcutaneous electrical nerve stimulation for acute pain.
        Cochrane Database of Systematic Reviews. 2009;