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Randomized Controlled Pilot Study of Transcutaneous Electrical Nerve Stimulation for Acute Back Pain in Emergency
Maxwell Moor-Smith1,2, Nicholas Kozak1, Michael McCue1
1University of British Columbia, Vancouver, BC, Canada.
Background:
Musculoskeletal back pain is a common presenting complaint to emergency departments (ED) worldwide. In this study we aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as an adjunct to standard care in reducing pain for patients presenting with acute low back pain.
Methods:
This study has a dual-center, open-label, cluster-randomized controlled trial design. Participants were recruited from two tertiary-care EDs in Canada. We included patients with acute or acute-on-chronic back pain of < 3 weeks duration. Participants were randomized to receive either TENS for 30 minutes plus standard care, or standard care alone. We measured pain scores using the Visual Analogue Scale (VAS) at baseline, 30 minutes, and 60 minutes after initiation of the intervention. The primary outcome was the difference in mean VAS pain scores at 60 minutes between the two groups.
Results:
Of 94 patients considered, we enrolled 25 participants (15 control and 10 intervention). The group receiving TENS plus standard care showed a statistically significant reduction in pain scores compared to the standard care alone group at both the 30-minute (relative mean difference: 22.6%; absolute difference: 1.7 points on 10-point VAS (95% CI, -31.9%, -13.4%, P < .001) and 60-minute timepoints (relative mean difference 18.2%, absolute difference 1.4 points (-32.7%, -3.8%, P = .04). There were two return visits in the intervention group within two weeks from the index visit, and two patients reported slight discomfort with using TENS, although they kept the device on for the duration of the trial period.
Conclusion:
The addition of transcutaneous electrical nerve stimulation to standard care resulted in a modest but statistically significant reduction in pain scores for patients with acute back pain in the ED setting, although it did not meet our predefined threshold of clinical significance. Further research with larger sample sizes is required to clarify the effect size and role of TENS for acute back pain in the ED waiting room.
