Physiological Science Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil.
Department of Physical Therapy and Rehabilitation Science, Pain Research Program, University of Iowa, IA, USA.
Eur J Pain. 2018 Apr;22(4):663-678. doi: 10.1002/ejp.1168. Epub 2017 Dec 27.
We conducted a systematic review and meta-analysis analysing the existing data on transcutaneous electrical nerve stimulation (TENS) or interferential current (IFC) for chronic low back pain (CLBP) and/or neck pain (CNP) taking into account intensity and timing of stimulation, examining pain, function and disability. Seven electronic databases were searched for TENS or IFC treatment in non-specific CLBP or CNP. Four reviewers independently selected randomized controlled trials (RCTs) of TENS or IFC intervention in adult individuals with non-specific CLBP or CNP. Primary outcomes were for self-reported pain intensity and back-specific disability. Two reviewers performed quality assessment, and two reviewers extracted data using a standardized form. Nine RCTs were selected (eight CLBP; one CNP), and seven studies with complete data sets were included for meta-analysis (655 participants). For CLBP, meta-analysis shows TENS/IFC intervention, independent of time of assessment, was significantly different from placebo/control (p < 0.02). TENS/IFC intervention was better than placebo/control, during therapy (p = 0.02), but not immediately after therapy (p = 0.08), or 1-3 months after therapy (p = 0.99). Analysis for adequate stimulation parameters was not significantly different, and there was no effect on disability. This systematic review provides inconclusive evidence of TENS benefits in low back pain patients because the quality of the studies was low, and adequate parameters and timing of assessment were not uniformly used or reported. Without additional high-quality clinical trials using sufficient sample sizes and adequate parameters and outcome assessments, the outcomes of this review are likely to remain unchanged.
These data highlight the need for additional high-quality RCTs to examine the effects of TENS in CLBP. Trials should consider intensity of stimulation, timing of outcome assessment and assessment of pain, disability and function.
本系统评价和荟萃分析旨在分析现有关于经皮电神经刺激（TENS）或干扰电流（IFC）治疗慢性下腰痛（CLBP）和/或颈痛（CNP）的文献，考虑刺激强度和时间，评估疼痛、功能和残疾。检索了 7 个电子数据库，以获取 TENS 或 IFC 治疗非特异性 CLBP 或 CNP 的相关数据。4 位评审员独立筛选了 TENS 或 IFC 干预成人非特异性 CLBP 或 CNP 的随机对照试验（RCT）。主要结局指标为自我报告的疼痛强度和腰痛特异性残疾。2 位评审员进行质量评估，2 位评审员使用标准化表格提取数据。共纳入 9 项 RCT（8 项 CLBP，1 项 CNP），7 项具有完整数据集的研究纳入荟萃分析（655 名参与者）。对于 CLBP，荟萃分析显示，无论评估时间如何，TENS/IFC 干预与安慰剂/对照组均有显著差异（p<0.02）。TENS/IFC 干预在治疗期间优于安慰剂/对照组（p=0.02），但治疗后即刻（p=0.08）或治疗后 1-3 个月（p=0.99）无差异。充分刺激参数的分析无显著差异，对残疾也无影响。本系统评价提供的 TENS 治疗腰痛的疗效证据不明确，因为研究质量低，并且未统一使用或报告充分的参数和评估时间。在没有更多高质量的临床试验采用足够的样本量和充分的参数及结局评估的情况下，本综述的结果可能保持不变。
这些数据突出了在 CLBP 中进一步开展高质量 RCT 研究 TENS 疗效的必要性。试验应考虑刺激强度、结局评估时间以及疼痛、残疾和功能的评估。
