Dec. 30, 2009 -- A widely used, somewhat controversial treatment for chronic low back 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 WebMD.
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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 not.
"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."
AAN recommends that TENS be considered for the treatment of this type of pain.
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 nerve-related pain.
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 Neurology.
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 prescribing clinicians.
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 nerve-related pain.
"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.