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Acute Pain | Chronic Pain | General

Transcutaneous electrical nerve stimulation (TENS) in postoperative pain

Clinical bottom line:

TENS is not effective in the relief of postoperative pain. Patients should be offered effective methods of pain relief.


TENS was originally developed as a way of controlling pain through the 'gate' theory. There is conflicting professional opinion about the use of TENS in acute postoperative pain. For example, the Agency for Health Care Policy and Research recommended TENS as effective in reducing pain and improving physical function, whilst the UK College of Anaesthetists' working party stated that TENS is not effective as the sole treatment of moderate or severe pain after surgery.

Systematic review

Carroll D, Tramer M, McQuay H, Nye B, Moore A. Randomization is important in studies with pain outcomes: Systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain. British Journal of Anaesthesia 1996; 77:798-803.

Inclusion criteria were full journal publication; randomised, controlled trials; TENS; postoperative pain with pain outcomes; group size 10.

Statistically significant findings were extracted from the original reports, and then qualitatively summarised. Post-hoc subgroup analysis in the original reports was not considered in reviewer judgements of overall effectiveness.

Findings

TENS vs. sham TENS

Fourteen trials were included. None found any difference. One trial reported improved pain ratings with TENS, but statistical analysis was regarded as inappropriate by reviewers.

TENS vs. opioid control

Seven trials compared opioid plus TENS with opioid alone, four of which also included sham TENS. Five of seven trials reported no difference between groups. Of the two significant trials , one reported significantly fewer pethidine injections and higher global ratings of treatment scores on the first postoperative day. The second trial reported improved pain scores with TENS used for 20 minutes three times a day. Reviewers agreed with these findings.

Adverse effects

Data on adverse effects were not systematically collected in any trials, and none were reported.

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