Pain Relief From Non-pharmacological Rehabilitative Therapies for Musculoskeletal Injuries Immediately Following
Laura A Talbot1, Vanessa J Ramirez2, Tanekkia M Taylor-Clark3
1Department of Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, United States.
Introduction:
Musculoskeletal injuries, with loss of readiness in military warfighters, underscore the importance of therapies to reduce pain and accelerate recovery for return to duty. Non-pharmacologic interventions, including exercise and electrotherapy, may be beneficial in garrison and austere environments. A concern associated with electrotherapy is that the electrical current may intensify discomfort, resulting in reduced adherence and longer recovery. This secondary analysis examined whether electrotherapy (transcutaneous electrical nerve stimulation [TENS] and neuromuscular electro-stimulation [NMES]) affects pain immediately after usage compared to exercise alone.
Materials And Methods:
Session logs were used to record an 11-point numeric visual analog scale to evaluate pain, with values ranging from 0 (no pain) to 10 (worst pain), immediately before and after intervention sessions from 3 randomized controlled trials (RCTs): knee injury (KI), patellofemoral pain syndrome (PFPS), and subacute low back pain (S-LBP) studies. These trials utilized exercise alone or together with electrotherapy in the form of NMES and/or TENS. Electrical impulses and currents for NMES and TENS employed preset programs.
Results:
Participants in NMES groups experienced less pain immediately after therapy compared to before in all 3 RCTs (mean differences: KI = -0.15, PFPS = -0.21, S-LBP = -0.70). Conversely, exercise-alone groups perceived increased pain in 2 trials where measured (mean differences: PFPS = 0.59, S-LBP = 0.48). These effects remained consistent over the course of the trials. The level of pain improvement with TENS and NMES was positively associated with the level of pain immediately before therapy. The greater the pain before treatment, the greater the improvement in pain after treatment. In the PFPS study, a TENS group showed greater pain reduction than the NMES group (-0.33 vs. -0.21).
Conclusions:
In this secondary analysis of data from 3 RCTs, adding electrotherapy to exercise rehabilitation for knee or back injuries seems to reduce pain immediately following treatment. This may help warfighters in deployed or austere conditions to continue receiving treatment, facilitating a more rapid return to full duty.
