Robb Karen, Oxberry Stephen G, Bennett Michael I, Johnson Mark I, Simpson Karen H, Searle Robert D
St. Bartholomew's Hospital, London, United Kingdom.
J Pain Symptom Manage. 2009 Apr;37(4):746-53. doi: 10.1016/j.jpainsymman.2008.03.022. Epub 2008 Sep 14.
Cancer-related pain is complex and multi-dimensional; yet, the mainstay of cancer pain management has been the biomedical approach. There is a need for nonpharmacological and innovative pain management strategies. Transcutaneous electrical nerve stimulation (TENS) may have a role. The aim of this systematic review was to determine the effectiveness of TENS for cancer-related pain in adults. The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED, and PEDro databases were searched for randomized controlled trials (RCTs) investigating the use of TENS for the management of cancer-related pain in adults. Once relevant studies were identified, two pairs of reviewers assessed eligibility for inclusion in the review based on a study eligibility form and using the 5-point Oxford Quality Scale. Two RCTs met the study eligibility criteria (these involved 64 patients). These studies were heterogeneous with respect to study population, methodology, and outcome measures. This prevented meta-analysis. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-like TENS (AL-TENS) and sham in palliative care patients; this study was significantly underpowered. There is insufficient available evidence to determine the effectiveness of TENS in treating cancer-related pain. Further research is needed to help guide clinical practice, and large multi-center RCTs are required to assess the value of TENS in the management of cancer-related pain in adults.
癌症相关疼痛复杂且具有多维度特点；然而，癌症疼痛管理的主要方法一直是生物医学方法。需要非药物和创新的疼痛管理策略。经皮电刺激神经疗法（TENS）可能发挥作用。本系统评价的目的是确定TENS对成人癌症相关疼痛的有效性。检索了Cochrane图书馆、MEDLINE、EMBASE、CINAHL、PsychINFO、AMED和PEDro数据库，以查找调查TENS用于成人癌症相关疼痛管理的随机对照试验（RCT）。一旦确定了相关研究，两对评审员根据研究纳入标准表格并使用5分制牛津质量量表评估纳入该评价的资格。两项RCT符合研究纳入标准（涉及64名患者）。这些研究在研究人群、方法和结局测量方面存在异质性。这妨碍了进行荟萃分析。在一项RCT中，对于因乳腺癌治疗导致慢性疼痛的女性，TENS与安慰剂之间无显著差异。在另一项RCT中，对于姑息治疗患者，类针刺TENS（AL-TENS）与假治疗之间无显著差异；该研究的效能明显不足。没有足够的现有证据来确定TENS治疗癌症相关疼痛的有效性。需要进一步研究以指导临床实践，并且需要大型多中心RCT来评估TENS在成人癌症相关疼痛管理中的价值。
