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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Article info
Publication history
Published online: April 11, 2011
Accepted:
February 22,
2011
Received in revised form:
February 4,
2011
Received:
August 26,
2010
Footnotes
Supported by the Research & Development Office, Northern Ireland (UK) and Strategic Priority Grant, Department for Employment and Learning, Northern Ireland (UK). The TENS units and electrodes were donated by Empi (USA) and TensCare (UK).
Conflicts of interest: delivery of occasional workshops on TENS sponsored by TENS and pharmaceutical companies (Mark Johnson); consultant and research contract with Medtronic and consultant for Regeneron (Kathleen Sluka).
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
