Gadsby J G, Flowerdew M W
De Montfort University, 47 Milton Crescent, Leicester, Leicestershire, UK, LE4 OPA.
Cochrane Database Syst Rev. 2007 Jul 18;2006(1):CD000210. doi: 10.1002/14651858.CD000210.pub2.
In view of the claims and counter-claims of the effectiveness of transcutaneous electrical nerve stimulation, it would seem appropriate to systematically review the literature.
To determine the effectiveness of transcutaneous electrical nerve stimulation in reducing pain and improving range of movement in patients with chronic low back pain.
Electronic searches of EMBASE, MEDLINE, CISCOM, AMED for all studies of TENS in the English language, identifying those treating chronic low back pain and hand searching their references.
The inclusion criterion for studies included in this review, 6 of 68 identified, was comparisons of TENS/ALTENS versus placebo in patients with chronic low back pain.
Outcome data on pain reduction, range of movement, functional status and work was extracted by two independent reviewers together with trial design qualities to construct a Quality Index.
The ratio of odds of improvement in pain for each comparison was calculated: TENS vs. placebo at 1.62 (95% CI 0.90, 2.68); ALTENS vs. placebo at 7.22 (95% CI 2.60, 20.01) and TENS/ALTENS vs. placebo at 2.11 (95% CI 1.32, 3.38) times that of placebo. An improvement in pain reduction was seen in 45.80% (CI 37.00%, 55.00%) of TENS; 86.70% (CI 80.00%, 93.00%) of ALTENS; 54.00% (CI 46.20%, 61.80%) of TENS/ ALTENS and 36.40% (95%CI 28.40%, 44.40%) of placebo subjects. The odds of improvement in range of movement on ALTENS vs. placebo was 6.61 times (95% CI 2.36, 18.55) that of placebo.
AUTHORS' CONCLUSIONS: Transcutaneous electrical nerve stimulation appears to reduce pain and improve the range of movement in chronic low back pain subjects. A definitive randomised controlled study of ALTENS, TENS, placebo/no treatment controls, of sufficient power, is needed to confirm these findings.
鉴于经皮电刺激神经疗法有效性的各种主张及反驳观点，系统回顾相关文献似乎是恰当的。
确定经皮电刺激神经疗法在减轻慢性下腰痛患者疼痛及改善其活动范围方面的有效性。
通过电子检索EMBASE、MEDLINE、CISCOM、AMED，查找所有英文的经皮电刺激神经疗法研究，找出那些治疗慢性下腰痛的研究，并人工检索其参考文献。
本综述纳入的研究（在68项确定的研究中选了6项）的纳入标准是对慢性下腰痛患者进行经皮电刺激神经疗法/交替性经皮电刺激神经疗法与安慰剂的比较。
两名独立的审阅者提取了关于疼痛减轻、活动范围、功能状态和工作方面的结果数据，以及试验设计质量数据，以构建一个质量指数。
计算了每次比较中疼痛改善的优势比：经皮电刺激神经疗法与安慰剂相比为1.62（95%可信区间0.90，2.68）；交替性经皮电刺激神经疗法与安慰剂相比为7.22（95%可信区间2.60，20.01）；经皮电刺激神经疗法/交替性经皮电刺激神经疗法与安慰剂相比为2.11（95%可信区间1.32，3.38）倍于安慰剂。经皮电刺激神经疗法组45.80%（可信区间37.00%，55.00%）的患者疼痛减轻有改善；交替性经皮电刺激神经疗法组为86.70%（可信区间80.00%，93.00%）；经皮电刺激神经疗法/交替性经皮电刺激神经疗法组为54.00%（可信区间46.20%，61.80%）；安慰剂组为36.40%（95%可信区间28.40%，44.40%）。交替性经皮电刺激神经疗法与安慰剂相比，活动范围改善的优势比是安慰剂的6.61倍（95%可信区间2.36，18.55）。
经皮电刺激神经疗法似乎能减轻慢性下腰痛患者的疼痛并改善其活动范围。需要进行一项关于交替性经皮电刺激神经疗法、经皮电刺激神经疗法、安慰剂/无治疗对照且有足够效力的确定性随机对照研究来证实这些发现。
