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Acute Pain | Chronic Pain | General

Transcutaneous electrical nerve stimulation (TENS) in labour pain

Clinical bottom line: TENS does not alleviate labour pain nor reduce the use of additional analgesics. Women should be offered effective interventions for relief of labour pain.


TENS was originally developed as a way of controlling pain through the gate theory. It has become popular for a variety of different acute and chronic pain conditions. In Canada and UK TENS is widely available for women in labour.

Systematic review

Carroll D, Moore RA, Tramèr MR, McQuay HJ. Transcutaneous electrical nerve stimulation does not relieve labour pain: updated systematic review. Contemporary Reviews in Obstetrics and Gynecology 1997; Sept:195-205.

Inclusion criteria were full journal publication, TENS, labour pain with pain outcomes, random treatment allocation and group size of at least 10. Effectiveness was judged as significant improvement on at least one study outcome measure. Primary outcomes were prospective measurements of pain at time of labour and when TENS was in use. Secondary outcomes were retrospective assessments of pain, pain relief or other measures after labour or after discontinuation of TENS. Secondary outcomes included the use of additional pain interventions, their timings and any retrospective global evaluations of study treatments. The reviewers judged whether the overall conclusion of each report was positive or negative for the analgesic effectiveness of TENS on primary and secondary outcomes separately. Based on patient need for additional analgesic treatment, relative benefit and numbers-needed-to-treat were calculated with 95% confidence intervals (CI) (with a random effect model for non-homogenous data).

Findings

No study recorded any difference in pain intensity or pain relief scores between TENS and control during labour. Eight of 10 reports recorded additional analgesic interventions. Two of 10 studies reported on the total number of interventions per group. Figures suggested a decrease in total interventions with TENS, but group sizes were very modest.

Five of 10 studies reported on numbers of women per group receiving additional analgesic intervention. There was no difference between active and sham TENS in the three largest of these studies. The final study reported on all interventions other than epidurals.

Figure: Additional analgesics in trials comparing active TENS with sham TENS. Total number of patients in the comparison are shown

The combined result of these five studies generated a relative benefit of 0.88 (0.72 - 1.07). This lack of significance obviated the need to calculate a number-needed-to-treat .

Adverse effects

There were no reports of adverse effects in any of the ten studies.

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