A comparison of high versus low intensity transcutaneous electrical nerve stimulation for chronic pain

  • Diyar Hussein Tahir Department of Psychiatry, College of Medicine, Hawler Medical University, Erbil, Iraq.
Keywords: transcutaneous electrical nerve stimulation, analgesia

Abstract

Background and objectives: Over the last 35 years electrical nerve stimulation has been employed increasingly in the treatment of chronic pain. This study was carried out to compare the analgesic effect that produced by applying a fixed frequency (50 Hz) high intensity tolerably painful transcutaneous electrical nerve stimulation (TENS) with the conventional low intensity TENS.

Methods:

Thirty six patients (26 Females and 10 males with age 18 – 54 years) were selected from patients consulting a private psychiatric clinic in Erbil city from March 2009 to march 2010. They had chronic pain in head and neck for more than 2 years. The cases were allocated randomly into two groups; group A treated by the conventional TENS of high frequency 100 Hz with low intensity current, by applying the electrical electrodes on the nucheal region (back of neck) for 20 minutes once daily for six days, and once weekly for one month then follow up the patients after 3 months, while in group B; the same procedure was applied but with fixed frequency 50 Hz and high intensity current adjusted to a tolerably painful level. The pain measured by verbal scale ranged from 0 to 4.  

Results: Patients who received high intensity TENS; 94% of them got immediate pain relief and 17% got long lasting pain relief more than three months, while with the conventional TENS only 33% got immediate pain relief and no one got long lasting pain relief.

Conclusion: The tolerably painful high intensity TENS gives better analgesic effect than the conventional TENS, and in some patients it may leads to long lasting analgesic effect(this may be attributed to the pan stimulation involving a variety of afferent fibers; Aa/β, Ad & C).

References

Melzack R, Wall PD. Pain mechanisms; a new theory. Science 1965;150 (699):971-9. Available from: http://www.medscape.com/medline/abstract/5320816.

Jensen JE, Conn RR, Hazelrigg G, Hewett JE. "The use of transcutaneous neural stimulation and isokinetic testing in arthroscopic knee surgery". Am J Sports Med 1985; 13 (1):2733.

Johnson M, Martinson, M. "Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: A meta-analysis of randomized controlled trials". Pain 2007; 130 (1): 157–65.

Nnoaham KE, Kumbang J. Transcutaneous electrical nerve stimulation (TENS) for chronic pain. Cochrane Database Syst Rev. 2008;7:16.

Fernandez-Del-Olmo M, Alvarez-Sauco M, Koch G, et al. How repeatable are the physiological effects of TENS?. Clin Neurophysiol. 2008;119 (8):1834-9.

Robertson V, Ward A, Low J, Reed A. Electrotherapy Explained: Principles and Practice, 4th ed. Philadelphia: Butterworth-Heinemann (Elsevier); 2006.

Robinson AJ, Snyder-Mackler L. Clinical Electrophysiology: Electrotherapy and Electrophysiologic Testing. 3rd ed. USA: Lippincott Williams & Wilkins; 2007.

Duggan A W. Foong FW. Bicuculine and spinal inhibition produced by dorsal column stimulation in the cat. Pain 1985; 22; 249-59.

Johnson MI, Ashton CH, Thompson JW, An in-depth study on long term users of transcutaneous electrical nerve stimulation (TENS). Implications for clinical use of TENS. Pain 1991; 44; 221- 29

Hughes G., Lichstein P., Whitlock D., harker C. Response of plasma beta-endorphins to trancutaneous electrical nerve stimulation in healthy subjects; Physical Therapy 1984; 64 (7): 1062-6.

Garrison. DW and Foreman R. D. Effect of prolonged transcutaneous electrical nerve stimulation(TENS) and variation of stimulation variable on dorsal horn cell activity. Pain. 1996; 6: 87-94.

Sandkühler J. Long-lasting analgesia following TENS and acupuncture: Spinal mechanisms beyond gate control. In: Proceedings of the 9th World Congress on Pain, Progress in Pain Research and Management, Vol.16. Devor M, Rowbotham MC, Wiesenfeld-Hallin Z, eds. Seattle: IASP Press; 2000. P. 359–369.

Cheing GL, Hui-Chan CW. Transcutaneous electrical nerve stimulation: nonparallel antinociceptive effects on chronic clinical pain and acute experimental pain. Arch Phys Med Rehabil. 1999; 80(3): 305-12.

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". Eur J Pain 2003; 7 (2): 181–8.

Rakel B, Frantz R. "Effectiveness of transcutaneous electrical nerve stimulation on postoperative pain with movement". J Pain 2003; 4 (8): 455–64.

Thorsen SW, Lumsden SG, Trigeminal neuralgia; sudden and long term remission with transcutaneous electrical nerve stimulation. Physiol Ther 1997; 20: 415-9.

Published
2018-10-23
How to Cite
Tahir, D. (2018). A comparison of high versus low intensity transcutaneous electrical nerve stimulation for chronic pain. Zanco Journal of Medical Sciences (Zanco J Med Sci), 15(2), 51-56. Retrieved from https://zjms.hmu.edu.krd/index.php/zjms/article/view/445
Section
Original Articles