Fifteen years of transcutaneous electrical stimulation for pain control

Transcutaneous electrical stimulation was reintroduced into medical practice in the early 1970s. Since that time, numerous studies, both controlled and uncontrolled, have suggested its utility for the treatment of pain related to acute musculoskeletal injury, postoperative pain, pain of peripheral vascular origin, pain of myocardial ischemia and chronic pain of a variety of causes. Pain of labor in delivery is affected equivocally. Pain complicating cancer has not been reliably relieved. A small number of controlled studies fail to demonstrate benefit, but the preoponderance of evidence suggests that electrical stimulation of the peripheral nervous system is a useful adjunct in the management of many pain states. Most studies indicate that the resultant analgesia is not opioid-dependent. Pain threshold and perception both appear to be reduced. The physiological mechanism by which pain is affected is not defined; local neural blockade, branch block in the dorsal horn and activation of a central inhibitory system have all been postulated.