WebMD Medical News
Louise Chang, MD
Dec. 30, 2009 -- A widely used, somewhat controversial treatment for chronic
pain is not effective and cannot be recommended, the American Academy of
Neurology (AAN) now says.
Transcutaneous electric nerve stimulation, or TENS, is a pocket-sized,
battery-operated device that sends electric currents to the nerves via
electrodes with the goal of treating pain.
TENS has been used for pain relief for four decades, but
studies evaluating its effectiveness have been mixed.
A review of the available research assessing the use of TENS for pain led to
the newly published recommendation against its use for chronic low back pain,
says neurologist and guideline co-author Richard M. Dubinsky, MD, MPH, of
Kansas University Medical Center.
"From the systematic review of the literature, based on the strength of the
studies, we can say that TENS does not work for low back pain," he tells
The AAN researchers reviewed TENS studies involving patients with chronic
low back pain lasting three months or longer. All but one study excluded people
with known causes of low back pain, such as pinched nerves, curving of the
spine, or vertebra displacement.
Although some of the studies did show a benefit for TENS, the two most
rigorously designed and executed trials reviewed by the researchers did
"We can’t say that TENS will not work in any patient with chronic low back
pain," Dubinsky says. "We can say there is proof it doesn’t work in groups of
patients with chronic low back pain."
The nerve-stimulating therapy was found to be probably effective for the
treatment of nerve pain associated with diabetes, known as diabetic
AAN recommends that TENS be considered for the treatment of this type of
But the researchers concluded that too little research has been done to
recommend or advise against the use of TENS for the treatment of other types of
They wrote that "the evidence for the efficacy of TENS in treating pain
associated with neurologic disorders is meager."
The revised guidelines appear in the Dec. 30 issue of the AAN journal
Dubinsky says he expects the recommendation against the use of TENS for the
treatment of chronic low back pain to be controversial among patients and
In the same issue of Neurology, nerve pain researcher Andreas Binder,
MD, of Germany’s Christian-Albrechts University argues that the fact that TENS
is still widely used for the treatment of nerve-related pain suggests that it
is effective for some patients.
He points out that TENS is easy to use and can be discontinued quickly if it
is not working.
He concludes that despite the relatively weak scientific and clinical
evidence, TENS still represents a valuable therapeutic treatment for
"Taking the favorable benefit-risk ratio when compared with other
pain-relieving methods into account, TENS remains a valuable part in the
armamentarium of pain therapy," he writes.
SOURCES:Dubinsky, R.M. and Binder, A. Neurology, Jan. 12, 2010; online
edition.Richard M. Dubinsky, MD, MPH, associate professor, department of neurology,
Kansas University Medical Center.News release. American Academy of Neurology.
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