Scolaris Content Display Scolaris Content Display

Study flow diagram.

Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 TENS versus sham TENS, outcome: 1.1 Pain intensity.

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Figure 4

Forest plot of comparison: 1 TENS versus sham TENS, outcome: 1.1 Pain intensity.

Forest plot of comparison: 1 TENS versus sham TENS, outcome: 1.2 Pain intensity sensitivity analysis (Celik 2013 removed).

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Figure 5

Forest plot of comparison: 1 TENS versus sham TENS, outcome: 1.2 Pain intensity sensitivity analysis (Celik 2013 removed).

Comparison 1: TENS versus sham TENS, Outcome 1: Pain intensity

Figuras y tablas -
Analysis 1.1

Comparison 1: TENS versus sham TENS, Outcome 1: Pain intensity

Comparison 1: TENS versus sham TENS, Outcome 2: Pain intensity sensitivity analysis (Celik 2013 removed)

Figuras y tablas -
Analysis 1.2

Comparison 1: TENS versus sham TENS, Outcome 2: Pain intensity sensitivity analysis (Celik 2013 removed)

Summary of findings 1. TENS versus sham TENS

TENS versus sham TENS for neuropathic pain in adults

Patient or population: adults with neuropathic pain

Settings: secondary care

Intervention/comparison: TENS vs sham TENS

Outcome: Pain intensity (VAS)

Outcomes

Effect estimate

(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Post‐intervention pain intensity

(VAS 0‐10)

Favoured TENS. Mean difference

‐1.58 (95% CI ‐2.08 to ‐1.09)

207 (5)

⊕⊝⊝⊝ Very lowa

Downgraded 3 levels due to multiple

sources of potential bias, small number

and size of studies.

Health related quality of life

No data

Participant global impression of change

No data

Analgesic medication use

Not estimable

Incidence/nature of adverse events

Not estimable

CI: confidence interval; TENS: transcutaneous electrical nerve stimulation; VAS: visual analogue scale.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different.
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

aDowngraded twice for limitations of studies and once for imprecision.

Figuras y tablas -
Summary of findings 1. TENS versus sham TENS
Table 1. Details of participants and TENS parameters in included studies

Study, comparison (admitted sample size)

Group baseline pain intensity VAS/NRS

Neuropathic condition

Reported mean duration

Diagnostic criteria

Hz and pulse width

Electrode location

Intensity

Duration, frequency and site of administration

Barbarisi 2010

TENS vs sham TENS (30)

P300 + TENS: 4 ± 0.93

P600 + TENS: 3.8 0.95

P300 + sham TENS: 4.1 ± 1.19

P600 + sham TENS: 3.2 ± 0.81

Postherpetic neuralgia

15.25 ± 8.7 months

No formal or clinical neuropathic diagnostic criteria

100 Hz (later described in text as 50 Hz)

125 µs

"Around site of pain"

"Clear non‐painful paraesthesia".

Titrated to maintain strength of perception

30 minutes daily for 4 weeks

Clinic administration

Bi 2015

TENS vs sham TENS (52)

TENS: 5.17 ± 2.34 Sham TENS: 5.56 ± 2.07

Spinal cord injury

6.9 ± 3.6 months (since spinal cord injury)

No formal or clinical neuropathic diagnostic criteria

2 Hz

200 ms

Placed "on region with pain"

50 mA. No description of perceived sensation

20 minutes 3 × weekly for 12 weeks

Clinic administration

Buchmuller 2012

TENS vs sham TENS (122)

TENS: 6.15 ± 2.24 Sham TENS: 5.91 ± 2.12

Lumbar radicular pain (subgroup data supplied by authors)

Not reported

Clinical assessment

Mixed: 80‐100 Hz alternated with 2 Hz

200 ms

Placed on low back and radicular region of pain

Low intensity paraesthesia alternated with high intensity (muscle twitches)

1 hour. 4 × daily for 3 months

Self‐administered at home

Casale 2013

TENS vs laser? (20)

TENS: 6 ± 0.8 Laser?: 6.6 ± 1.1

Carpal tunnel syndrome

Not reported

Nerve conduction study

100 Hz

80 ms

Over carpal ligament and median nerve

"Below muscle contraction"

30 minutes 5 × weekly for 3 weeks

Clinic administration

Celik 2013

TENS vs sham TENS (33)

TENS: 5.79 ± 2.17

Sham TENS: 5.64 ± 1.81

Spinal cord injury

19.1 months

LANSSa > 12

4 Hz

200 µs

Placed "on region with pain"

50 mA. No description of perceived sensation

30 minutes 1 × daily for

10 days

Clinic administration

Gerson 1977

TENS vs drug

treatment (29)

TENS: 27.0

Drug: 59.0

(0‐100)

Postherpetic neuralgia

No details

No formal or clinical neuropathic diagnostic criteria

No details

"Placed on affected dermatome"

No detail

15 minutes 1 × weekly for 4 weeks then 1 × fortnightly for 3 weeks

Ghoname 1999

TENS vs PENS (64)

TENS: 7.0 ± 1.9

PENS: 7.2 ± 1.8

Sham PENS: 6.6 ± 1.9

Lumbar radicular pain

21 ± 9 months

Clinical assessment.

Radiological assessment of nerve root compression

4 Hz

100 ms

Placed on posterior lower limb

"Highest tolerable sensation" without muscle twitch

30 minutes 3 × weekly for 3 weeks

Clinic administration

Koca 2014

TENS vs IFT (75)

TENS: 8.06 ± 0.55

IFT: 8.25 ± 0.4

Splint: 8.31 ± 0.6

Carpal tunnel syndrome

13.3 ± 6.3 months

Nerve conduction study

100 Hz

80 ms

Placed on "palmar aspect of hand/wrist"

No details

20 minutes 5 × weekly for 3 weeks

Clinic administration

Nabi 2015

TENS vs PRF sympathectomy (65)

TENS: 6.10

PRF sympathectomy: 6.46

(NRS)

Peripheral diabetic neuropathy

12.9 ± 3 years (since diabetes

onset)

Clinical diagnosis

80 Hz

200 µs

"Around shin and ankle"

"two to three times sensory threshold"

20 minutes 10 treatment sessions on alternate days

Clinic administration

Őzkul 2015

TENS vs visual illusion (26)

TENS: 5.33 ± 1.20

Visual

illusion:

5.33 ± 1.37

Spinal cord injury

12.4 ± 17.8 months

≥ 4 on DN4

80 Hz

180 µs

Bilaterally around spine above level of injury

"perceptible but comfortable"

30 minutes 5 × weekly for 2 weeks

Clinic administration

Prabhakar 2011

TENS vs cervical spine mobilisation (75)

Not stated

Cervical radicular pain (75)

No details

No formal or clinical neuropathic diagnostic criteria

100 Hz

50 µs

Placed at 'cervical spinal segment and distal dermatome

No details

30 minutes 10 sessions on alternate days over 3 weeks

Clinic administration

Rutgers 1988

TENS vs acupuncture (26)

Not stated

Postherpetic neuralgia

"3 months to 9 years"

No formal or clinical neuropathic diagnostic criteria

100 Hz

200 µs

"Either side of painful area"

"Fairly strong sensation"

3 × 30 minute clinic sessions week 1. Then home use for 5 weeks. No detail on home use frequency/duration

Serry 2015

TENS vs exercise

(60)

Not stated

Peripheral diabetic neuropathy

12.2 ± 2.3 years

(since onset of neuropathy

)

No formal or clinical neuropathic diagnostic criteria

15 Hz

250 µs

Lower leg/ankle

"Strong rhythmic muscle contractions"

30 minutes 3 × weekly for 8 weeks

Clinic administration

Tilak 2016

TENS vs mirror therapy

TENS: 5.00 ± 1.63

Mirror: 5.46 ± 1.67

Phantom limb pain

13 ± 1.5 days (since onset of phantom limb pain)

No formal or clinical neuropathic diagnostic criteria

No details

Site of pain contralateral limb

"Strong but comfortable"

20 minutes 1 × daily for 4 days

Clinic administration

Vitalii 2014

TENS vs sham TENS (25)

TENS: 8.09 ± 0.97

Sham TENS: 8.05 ± 1.05

Spinal cord injury

12.7 months

LANSS > 12

4 Hz

200 ms

Proximal and distal to pain region

50 mA. No description of perceived sensation

30 minutes 1 × daily for 10 days

Clinic administration

DN4: Douleur Neuropathique 4; IFT: interferential therapy; LANSS: Leeds Assessment of Neuropathic Symptoms and Signs pain scale; NRS: numerical rating scale; P300: pregabalin 300 mg; P600: pregabalin 600 mg; PENS: percutaneous electrical nerve stimulation; PRF: pulsed radiofrequency; TENS: transcutaneous electrical nerve stimulation; VAS: visual analogue scale.

Figuras y tablas -
Table 1. Details of participants and TENS parameters in included studies
Comparison 1. TENS versus sham TENS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Pain intensity Show forest plot

5

207

Mean Difference (IV, Random, 95% CI)

‐1.58 [‐2.08, ‐1.09]

1.2 Pain intensity sensitivity analysis (Celik 2013 removed) Show forest plot

4

174

Mean Difference (IV, Random, 95% CI)

‐1.44 [‐1.87, ‐1.02]

Figuras y tablas -
Comparison 1. TENS versus sham TENS