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Foundational Research Could Improve Future Transcutaneous Electrical Nerve Stimulation Evaluations.

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  • 1Pain Management Service, North Bristol NHS Trust, Bristol BS10 5NB, UK.

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Summary

High-quality evidence is needed for transcutaneous electrical nerve stimulation (TENS) effectiveness in chronic pain. Future trials should consider patient experiences and develop standardized TENS training to optimize benefits and improve quality of life.

Keywords:
complex interventionlow back painmusculoskeletal painpatient reported outcome measuresqualitative researchtranscutaneous electrical nerve stimulation

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Area of Science:

  • Pain Management
  • Neuromodulation
  • Rehabilitation Science

Background:

  • Limited high-quality evidence exists for transcutaneous electrical nerve stimulation (TENS) in chronic musculoskeletal pain, including low back pain.
  • Previous calls for high-quality randomized controlled trials (RCTs) to establish TENS effectiveness beyond placebo.
  • Qualitative evidence highlights the complexity of TENS as an intervention, influenced by patient context and usage strategies.

Purpose of the Study:

  • To expand the discussion on designing future TENS trials.
  • To address the lack of consensus on optimal TENS support and education.
  • To emphasize the need for contextualized outcomes in TENS research.

Main Methods:

  • Review and synthesis of existing evidence on TENS effectiveness and trial design.
  • Consideration of qualitative data on patient experiences and TENS complexity.
  • Identification of gaps in current TENS training and outcome measurement.

Main Results:

  • The complexity of TENS use, involving multiple patient-reported benefits and chosen contexts, requires careful consideration in evaluations.
  • A lack of standardized TENS education packages exists to support users in optimizing benefits.
  • Clinical and research outcomes are not adequately contextualized with specific usage strategies.

Conclusions:

  • Research is needed to establish consensus on TENS training content and delivery, informed by patients, clinicians, and researchers.
  • Development of an effective and acceptable TENS training course (TTC) is necessary to enhance patient knowledge, skills, and confidence.
  • Further research should focus on appropriate, contextualized TENS patient-reported outcomes to improve pain management and quality of life.