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Does transcutaneous electrical nerve stimulation affect pain, neuropathic pain, and sympathetic skin responses in the treatment of chronic low back pain? A randomized, placebo-controlled study

  • Yaksi, Elif (Department of Physical Medicine and Rehabilitation, Abant Izzet Baysal University, Faculty of Medicine) ;
  • Ketenci, Aysegul (Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul Faculty of Medicine) ;
  • Baslo, Mehmet Baris (Department of Neurology, Istanbul University, Istanbul Faculty of Medicine) ;
  • Orhan, Elif Kocasoy (Department of Neurology, Istanbul University, Istanbul Faculty of Medicine)
  • 투고 : 2020.09.13
  • 심사 : 2021.01.07
  • 발행 : 2021.04.01

초록

Background: The purpose of this study was to assess the effectiveness of transcutaneous electrical nerve stimulation (TENS) in chronic low back pain and neuropathic pain. Methods: Seventy-four patients aged 18-65 with chronic low back pain were included in the study. Baseline measurements were performed, and patients were randomized into three groups. The first group received burst TENS (bTENS), the second group conventional TENS (cTENS), and the third group placebo TENS (pTENS), all over 15 sessions. Patients' visual analogue scale (VAS) scores were evaluated before treatment (preT), immediately after treatment (postT), and in the third month after treatment (postT3). Douleur Neuropathique 4 Questions (DN4), the Modified Oswestry Low Back Pain Disability Questionnaire (MOS), the Beck Depression Inventory (BDI), and sympathetic skin response (SSR) values were also evaluated preT and postT3. Results: A statistically significant improvement was observed in mean VAS scores postT compared to preT in all three groups. Intergroup comparison revealed a significant difference between preT and postT values, that difference being assessed in favor of bTENS at multiple comparison analysis. Although significant improvement was determined in neuropathic pain DN4 scores measured at postT3 compared to preT in all groups, there was no significant difference between the groups. No statistically significant difference was also observed between the groups in terms of MOS, BDI, or SSR values at postT3 (P > 0.05). Conclusions: bTENS therapy in patients with low back pain is an effective and safe method that can be employed in short-term pain control.

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참고문헌

  1. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med 2009; 169: 251-8. https://doi.org/10.1001/archinternmed.2008.543
  2. Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010; 24: 769-81. https://doi.org/10.1016/j.berh.2010.10.002
  3. Weiner SS, Nordin M. Prevention and management of chronic back pain. Best Pract Res Clin Rheumatol 2010; 24: 267-79. https://doi.org/10.1016/j.berh.2009.12.001
  4. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 2015; 350: h444. https://doi.org/10.1136/bmj.h444
  5. Will JS, Bury DC, Miller JA. Mechanical low back pain. Am Fam Physician 2018; 98: 421-8.
  6. Freynhagen R, Baron R. The evaluation of neuropathic components in low back pain. Curr Pain Headache Rep 2009; 13: 185-90. https://doi.org/10.1007/s11916-009-0032-y
  7. Morlion B. Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components. Curr Med Res Opin 2011; 27: 11-33. https://doi.org/10.1185/03007995.2010.534446
  8. Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008; 70: 1630-5. https://doi.org/10.1212/01.wnl.0000282763.29778.59
  9. Jensen TS, Baron R, Haanpaa M, Kalso E, Loeser JD, Rice ASC, et al. A new definition of neuropathic pain. Pain 2011; 152: 2204-5. https://doi.org/10.1016/j.pain.2011.06.017
  10. Kaki AM, El-Yaski AZ, Youseif E. Identifying neuropathic pain among patients with chronic low-back pain: use of the Leeds Assessment of Neuropathic Symptoms and Signs pain scale. Reg Anesth Pain Med 2005; 30: 422-8.
  11. Mehra M, Hill K, Nicholl D, Schadrack J. The burden of chronic low back pain with and without a neuropathic component: a healthcare resource use and cost analysis. J Med Econ 2012; 15: 245-52. https://doi.org/10.3111/13696998.2011.642090
  12. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ 2006; 332: 1430-4. https://doi.org/10.1136/bmj.332.7555.1430
  13. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2017; 166: 493-505. https://doi.org/10.7326/m16-2459
  14. Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev 2008; 2008: CD003008.
  15. Vance CG, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag 2014; 4: 197-209. https://doi.org/10.2217/pmt.14.13
  16. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;150:971-9. https://doi.org/10.1126/science.150.3699.971
  17. Sluka KA, Walsh D. Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. J Pain 2003; 4: 109-21. https://doi.org/10.1054/jpai.2003.434
  18. Moran F, Leonard T, Hawthorne S, Hughes CM, McCrum-Gardner E, Johnson MI, et al. Hypoalgesia in response to transcutaneous electrical nerve stimulation (TENS) depends on stimulation intensity. J Pain 2011; 12: 929-35. https://doi.org/10.1016/j.jpain.2011.02.352
  19. Johnson M. Transcutaneous electrical nerve stimulation: review of effectiveness. Nurs Stand 2014; 28: 44-53. https://doi.org/10.7748/ns.28.40.44.e8565
  20. Topuz O, Ozfidan E, Ozgen M, Ardic F. Efficacy of transcutaneous electrical nerve stimulation and percutaneous neuromodulation therapy in chronic low back pain. J Back Musculoskelet Rehabil 2004; 17: 127-33. https://doi.org/10.3233/BMR-2004-173-407
  21. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17: 45-56. https://doi.org/10.1016/0304-3959(83)90126-4
  22. Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J, et al. Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain 2005; 114: 29-36. https://doi.org/10.1016/j.pain.2004.12.010
  23. Hudson-Cook N, Tomes-Nicholson K, Breen A. A revised Oswestry disability questionnaire. In: Back pain: new approaches to rehabilitation and education. Edited by Roland MO, Jenner JR. Manchester, Manchester University Press. 1989, pp 187-204.
  24. Hisli N. [A study on the validity of Beck depression inventory]. Psikol Derg 1988; 6: 118-22. Turkish.
  25. Milne S, Welch V, Brosseau L, Saginur M, Shea B, Tugwell P, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain. Cochrane Database Syst Rev 2001; 2: CD003008.
  26. Brosseau L, Milne S, Robinson V, Marchand S, Shea B, Wells G, et al. Efficacy of the transcutaneous electrical nerve stimulation for the treatment of chronic low back pain: a metaanalysis. Spine (Phila Pa 1976) 2002; 27: 596-603. https://doi.org/10.1097/00007632-200203150-00007
  27. Khadilkar A, Milne S, Brosseau L, Robinson V, Saginur M, Shea B, et al. Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain. Cochrane Database Syst Rev 2005; 3: CD003008.
  28. Marchand S, Charest J, Li J, Chenard JR, Lavignolle B, Laurencelle L. Is TENS purely a placebo effect? A controlled study on chronic low back pain. Pain 1993; 54: 99-106. https://doi.org/10.1016/0304-3959(93)90104-W
  29. Jarzem PF, Harvey EJ, Arcaro N, Kaczorowski J. Transcutaneous electrical nerve stimulation [TENS] for short-term treatment of low back pain-randomized double blind crossover study of sham versus conventional TENS. J Musculoskelet Pain 2005; 13: 11-7.
  30. van der Spank JT, Cambier DC, De Paepe HM, Danneels LA, Witvrouw EE, Beerens L. Pain relief in labour by transcutaneous electrical nerve stimulation (TENS). Arch Gynecol Obstet 2000; 264: 131-6. https://doi.org/10.1007/s004040000099
  31. Dubinsky RM, Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2010; 74: 173-6. https://doi.org/10.1212/WNL.0b013e3181c918fc
  32. Jin DM, Xu Y, Geng DF, Yan TB. Effect of transcutaneous electrical nerve stimulation on symptomatic diabetic peripheral neuropathy: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract 2010; 89: 10-5. https://doi.org/10.1016/j.diabres.2010.03.021
  33. Pieber K, Herceg M, Paternostro-Sluga T. Electrotherapy for the treatment of painful diabetic peripheral neuropathy: a review. J Rehabil Med 2010; 42: 289-95. https://doi.org/10.2340/16501977-0554
  34. Singla S, Prabhakar V, Singla RK. Role of transcutaneous electric nerve stimulation in the management of trigeminal neuralgia. J Neurosci Rural Pract 2011; 2: 150-2. https://doi.org/10.4103/0976-3147.83580
  35. Yameen F, Shahbaz NN, Hasan Y, Fauz R, Abdullah M. Efficacy of transcutaneous electrical nerve stimulation and its different modes in patients with trigeminal neuralgia. J Pak Med Assoc 2011; 61: 437-9.
  36. Forst T, Nguyen M, Forst S, Disselhoff B, Pohlmann T, Pfutzner A. Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using the new Salutaris device. Diabetes Nutr Metab 2004; 17: 163-8.
  37. Ghoname EA, White PF, Ahmed HE, Hamza MA, Craig WF, Noe CE. Percutaneous electrical nerve stimulation: an alternative to TENS in the management of sciatica. Pain 1999; 83: 193-9. https://doi.org/10.1016/S0304-3959(99)00097-4
  38. Pengel LH, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ 2003; 327: 323. https://doi.org/10.1136/bmj.327.7410.323
  39. Tsang A, Von Korff M, Lee S, Alonso J, Karam E, Angermeyer MC, et al. Common chronic pain conditions in developed and developing countries: gender and age differences and comorbidity with depression-anxiety disorders. J Pain 2008; 9: 883-91. https://doi.org/10.1016/j.jpain.2008.05.005
  40. Andersson GB. Epidemiological features of chronic low-back pain. Lancet 1999; 354: 581-5. https://doi.org/10.1016/S0140-6736(99)01312-4
  41. Oksuz E. Prevalence, risk factors, and preference-based health states of low back pain in a Turkish population. Spine (Phila Pa 1976) 2006; 31: E968-72. https://doi.org/10.1097/01.brs.0000247787.25382.3c
  42. Kara H, Abay E. [Psychiatric approach to chronic pain]. Anadolu Psikiyatri Derg 2000; 1: 89-99. Turkish.
  43. Vetrugno R, Liguori R, Cortelli P, Montagna P. Sympathetic skin response: basic mechanisms and clinical applications. Clin Auton Res 2003; 13: 256-70. https://doi.org/10.1007/s10286-003-0107-5
  44. Erdem Tilki H, Coskun M, Unal Akdemir N, Incesu L. Axon count and sympathetic skin responses in lumbosacral radiculopathy. J Clin Neurol 2014; 10: 10-6. https://doi.org/10.3988/jcn.2014.10.1.10
  45. El-Badawy MA, El Mikkawy DM. Sympathetic dysfunction in patients with chronic low back pain and failed back surgery syndrome. Clin J Pain 2016; 32: 226-31. https://doi.org/10.1097/AJP.0000000000000250
  46. Perry J, Green A, Singh S, Watson P. A randomised, independent groups study investigating the sympathetic nervous system responses to two manual therapy treatments in patients with LBP. Man Ther 2015; 20: 861-7. https://doi.org/10.1016/j.math.2015.04.011
  47. Perry J, Green A. A longitudinal observational clinical study of neurophysiological and patient-reported responses to a program of physiotherapy for acute and subacute low back pain. J Manipulative Physiol Ther 2018; 41: 456-66. https://doi.org/10.1016/j.jmpt.2017.11.003
  48. Okuyucu EE, Turhanoglu AD, Guntel M, Yilmazer S, Savas N, Mansuroglu A. Does transcutaneous nerve stimulation have effect on sympathetic skin response? J Clin Neurosci 2018; 47: 160-2. https://doi.org/10.1016/j.jocn.2017.08.033
  49. Aramaki S, Kira Y, Hirasawa Y. A study of the normal values and habituation phenomenon of sympathetic skin response. Am J Phys Med Rehabil 1997; 76: 2-7. https://doi.org/10.1097/00002060-199701000-00002