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Randomized Pilot Study of Transcutaneous Electrical Nerve Stimulation for Neuropathic/Nociplastic Ocular Pain
Chloe Shields1, Sakina Qazi1, Ana Zaldivar2
1From the Surgical and Research Services (C.S., S.Q., A.G., E.R.F.), Department of Veterans Affairs Medical Center, Miami, Florida, USA; Bascom Palmer Eye Institute (C.S., S.Q., S.M.M., A.G.), University of Miami, Miami, Florida, USA.
Transcutaneous electrical nerve stimulation (TENS) provided short-term relief for ocular pain. High-frequency TENS (hfTENS) offered sustained benefits for neuropathic-like symptoms at three months, with baseline pain severity predicting response.
Area of Science:
- Ophthalmology
- Neurology
- Pain Management
Background:
- Chronic neuropathic/nociplastic ocular pain (NOP) presents a significant clinical challenge.
- Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, non-pharmacologic therapy explored for chronic pain.
- This study investigates TENS efficacy and response predictors in patients with NOP.
Purpose of the Study:
- To evaluate the analgesic effectiveness of TENS in individuals with chronic NOP.
- To identify predictors of TENS treatment response in this patient population.
Main Methods:
- Prospective, randomized, controlled pilot study involving 37 participants with moderate to severe chronic NOP.
- Participants received either high-frequency TENS (hfTENS) or low-frequency TENS (lfTENS) for 20 minutes, three times per week for six months.
- Outcomes included pain intensity (NRS), NOP symptom severity (NPSI-Eye), quantitative sensory testing (QST), and ocular examinations.
Main Results:
- Both hfTENS and lfTENS significantly reduced ocular pain intensity acutely.
- hfTENS demonstrated sustained improvements in specific NOP symptom subscores (pressing and paroxysmal pain) at three months.
- Baseline predictors of long-term response included lower NPSI-Eye scores and reduced sensitivity to noxious heat stimuli.
Conclusions:
- TENS, both hfTENS and lfTENS, effectively reduces NOP symptoms short-term.
- hfTENS shows potential for sustained analgesia for neuropathic-like symptoms.
- Baseline NOP severity and cutaneous sensitivity predict treatment response, suggesting potential for TENS as a neuromodulatory treatment for NOP.
