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Transcutaneous electrical nerve stimulation in the treatment of chronic pain: predictive factors and evaluation of
C Lampl1, T Kreczi, D Klingler
1Department of Neurology, Psychiatry and Pain Clinic, General Hospital Linz, Austria.
Objective:
Transcutaneous electrical nerve stimulation (TENS) is a widely used therapeutic approach in acute and chronic pain syndromes. The aim of this study was to investigate the influence of patient management as well as other factors on the outcome of TENS treatment.
Design:
The study was carried out as a retrospective analysis of the course of treatment and the therapeutic results of transcutaneous electric nerve stimulation (TENS) in 482 patients with chronic pain of various origins. The follow-up period was up to 48 months. Two groups with differing patient management were compared.
Results:
Competent patient evaluation and education (i.e., a long testing and learning phase as well as regular comprehensive after-care) was found to be important. Our analysis of the reasons for the discontinuation of long-term TENS therapy showed that the most important feature was the discrepancy between effort and therapeutic result. Other causes were intermittent depressive states and progression of the underlying disease followed by an aggravation of pain. In addition, numerous factors were identified that adversely affected the outcome of TENS treatment. These factors were listed in order of importance and were included in a prognostic score.
Conclusions:
The prognostic score permits an efficient selection of patients. Moreover, a comprehensive documentation of pain syndromes and their organic, psychogenic, and social features is presented. On the basis of this documentation, an appropriate therapeutic concept may be established. The prognostic score was validated in a subsequent study including 99 patients with chronic pain treated with TENS.