Jauregui Julio J, Cherian Jeffrey J, Gwam Chukwuweike U, Chughtai Morad, Mistry Jaydev B, Elmallah Randa K, Harwin Steven F, Bhave Anil, Mont Michael A
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
Adult Reconstruction Service, Mount Sinai Beth Israel, New York, New York.
Surg Technol Int. 2016 Apr;28:296-302.
OBJECTIVE: Transcutaneous electrical nerve stimulation (TENS) may provide a safe alternative to current side-effect-heavy narcotics and anti-inflammatories utilized in chronic low back pain. Therefore, we performed a meta-analysis to evaluate the efficacy of TENS for the treatment of chronic low back pain. MATERIALS AND METHODS: We included randomized controlled trials (RCTs), cohort studies, and randomized crossover studies on TENS for the management of low back pain. We utilized a visual analogue scale (VAS) for pain as our primary outcome. Effectiveness of treatment was quantified using improvement in outcome scores for each study. Of the studies that met the criteria, 13 allowed for calculation of weighted mean differences in pain reduction. We used a random model effect to evaluate changes in pain produced by the intervention. RESULTS: Included were nine level I and four level II, encompassing 267 patients (39% male) who had a mean follow-up of seven weeks (range; 2 to 24 weeks). The mean duration of treatment was six weeks (range; 2 to 24 weeks). The standardized mean difference in pain from pre- to post-treatment for TENS was 0.844, which demonstrated significant improvement of TENS on pain reduction. When subdividing treatment duration, patients that were treated for < 5 weeks had significant effects on pain, while those treated for > 5 weeks did not. CONCLUSION: Treatment of chronic low back pain with TENS demonstrated significant pain reduction. The application of TENS may lead to less pain medication usage and should be incorporated into the treatment armamentarium for chronic low back pain.
目的:经皮电刺激神经疗法(TENS)可能为目前用于慢性下腰痛且副作用严重的麻醉药和抗炎药提供一种安全的替代方法。因此,我们进行了一项荟萃分析,以评估TENS治疗慢性下腰痛的疗效。 材料与方法:我们纳入了关于TENS治疗下腰痛的随机对照试验(RCT)、队列研究和随机交叉研究。我们使用视觉模拟评分法(VAS)评估疼痛作为主要结局指标。每项研究的治疗效果通过结局评分的改善来量化。在符合标准的研究中,有13项可以计算疼痛减轻的加权平均差。我们使用随机模型效应来评估干预措施所产生的疼痛变化。 结果:纳入了9项I级和4项II级研究,共267例患者(39%为男性),平均随访7周(范围为2至24周)。平均治疗持续时间为6周(范围为2至24周)。TENS治疗前后疼痛的标准化平均差为0.844,这表明TENS在减轻疼痛方面有显著改善。当细分治疗持续时间时,治疗时间<5周的患者对疼痛有显著影响,而治疗时间>5周的患者则没有。 结论:TENS治疗慢性下腰痛可显著减轻疼痛。TENS的应用可能会减少止痛药的使用,应纳入慢性下腰痛的治疗手段中。
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